[Low anterior resection in the curative surgical treatment of rectal cancer].
Abdominoperineal resection for rectal cancer are being performed with decreasing frequency in favour of sphincter-saving resections. It remains to be demonstrated that sphincter preservation has not resulted in compromised local disease control and survival. For this purpose 342 patients with rectal carcinoma have been studied. A curative resection has been carried out in 232. Sphincter-saving procedure was performed whenever possible: the length of margin of resection was at least 2 cm. The operation were: 71 abdominoperineal excisions (AP), 147 anterior resections (AR), 14 transanal excisions. The thirty-days mortality was 7 patients (9.9%) for AP and 5 (3.4%) for AR. Local recurrence was: AP 10 cases (15.6%), AR 16 cases (11.3%); for tumors 4-8 cm from anal verge recurrence was 17.1% for AP, 16.2% for AR. Concerning staging, local recurrence was more common in the Dukes C stage (24.3%) than in the Dukes B (10.2%) or in the Dukes A (3.8%). 5 years survival after AP was 62.2 percent and after AR 67.9 percent. Concluding, in our experience, there was no relationship between local recurrence or survival and type of curative surgery (AP or AR). Local recurrence and survival were only related to tumor stage: lateral tumor extension in these advanced and aggressive lesions appears to be the major determinant of local recurrence. Further investigations are necessary to determine whether the addition of adjuvant radiotherapy or of extended abdomino-iliac lymphadenectomy should be able to improve the results.