The intersphincteric resection of distal rectal cancer. Indication, local recurrence, complications, sphincter function

From October 1992 to December 1996, 204 patients with rectal cancer were tr eated with tumor resection. Of all carcinomas 94 were localised in the dist al, 71 in the middle and 39 in the proximal third of the rectum. Curative r esection could be achieved in 74 % to 85 % of the cases depending on tumor localisation. A local R0-resection (no residual tumor) was achieved in 92 % to 100 %, partly due to preoperative radiochemotherapy in cases of locally advanced cancer. The percentage of protective stoma application ranged fro m 25 % of the total number of resections to 89 % in those cases with inters phincteric rectal resection. The peri- and postoperative complications were thoroughly documented. The number of complications increased with the dist al extent of rectal resection. The median follow up period was 24.5 months. Local tumor recurrence was observed in 6 cases (3.1 %) independent of the tumor location. Distant metastasis was seen in 16 % of all patients during the follow up period. 73 % of all patients are still alive, 23 % died of tu mor related and 4 % of non tumor related reasons. Complete postoperative st ool continence was reported by 73 % of all patients, 14 % were incontinent for liquid stool and 13 % were affected by total stool incontinence. Exclud ing those who underwent rectum exstirpation, 39 % of the patients had a sto ma. The extent of stool continence was closely related to the operative pro cedure. With intersphincteric resection, complete stool continence could on ly be achieved in 40 % of the patients whereas 18 % were incontinent for li quid stool, 14 % were completely incontinent and 29 % had a stoma at the ti me of observation. The rate of local recurrence was not increased after int ersphincteric resection.