The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum

This retrospective series comprises 902 patients who underwent curative resection of the sigmoid colon, rectosigmoid, and upper rectum at the Mayo Clinic during the years 1959 to 1969. Lesions were divided according to the location from the dentate line, with 346 patients having had a lesion located more than 20 cm from the dentate line; in the remaining 556 patients, the lesion was between 6 and 20 cm distant. A thorough analysis was undertaken comparing these two groups of patients on the basis of operative mortality and morbidity, including anastomotic complications, 5- and 10-year survival, and incidence of local recurrence. Overall operative mortality was 1.9%, with an 8.1% incidence of anastomotic complications. The overall 5-year survival rate was 72% and the 10-year survival rate was 55%. The incidence of anastomotic recurrence for anastomosis performed with the use of extraperitoneal rectum was 5.8%; recurrence at the suture line developed in 2.9% of patients who underwent anastomosis to serosa-covered bowel. In addition to the above data, information will be presented which demonstrates the effect of the patient's height and weight on the surgeon's ability to perform a low-anterior anastomosis. Finally, the incidence of anastomotic complications and of local recurrence were analyzed according to the intestinal preparation employed, the use of parenteral antibiotics , and the method of drainage used near the anastomosis.