Impact of total mesorectal excision on the results of surgery of distal rectal cancer

Abstract

Background: This study reviewed the results of surgery for distal rectal cancer (tumours within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. Methods: Two hundred and five patients who had undergone surgical resection of rectal cancer within 6 cm of the anal verge were included. The demographic, operative and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures. Results: Abdominoperineal resection (APR) was performed in 27·8 per cent of patients, falling from 36·0 per cent in the first 3 years to 20·0 per cent in the last 3 years of the study. The overall operative mortality rate was 1·5 per cent and the morbidity rate 30·2 per cent. With a mean follow-up of 36 months, local recurrence occurred in 28 of the 185 patients who had curative resection. The 5-year actuarial local recurrence rates for double-stapled anastomosis, peranal coloanal anastomosis and APR were 11·2, 34·6 and 23·5 per cent respectively. The local recurrence rate was significantly lower for double-stapled low anterior resection than for the other types of operation. The overall 5-year survival rate in patients with low anterior resection and APR was 69·1 and 51·1 per cent respectively (P = 0·12). Conclusion: With the practice of total mesorectal excision, APR was necessary in only 27·8 per cent of patients with rectal cancer within 6 cm of the anal verge. The local recurrence rate was much lower in patients with double-stapled low anterior resection than in those treated with APR or peranal anastomosis.