Cancer of the rectum: comparison of two different surgical approaches

Surgical treatment of rectal cancer is still controversial as regards the type of operation and the extent of lymphadenectomy. Four hundred and fifty-eight patients with rectal cancer operated on at two different hospitals (206 patients, Surgical Department, S. Martino General Hospital and 252 patients, Surgical Department, Galliera General Hospital) in the decade 1980-1989 were studied. None of the patients were submitted to adjuvant or neoadjuvant therapy. The operations opted for were anterior resection for carcinoma of the upper rectum, anterior resection or abdominoperineal resection for carcinoma of the middle rectum, and abdominoperineal resection for lower rectal cancer. At the S. Martino General Hospital, anterior resection comprised ligation of the inferior mesenteric artery at its origin, with subsequent preaortic lymphadenectomy. In abdominoperineal resection, the pelvis was left open and was closed later. At the Galliera General Hospital, preaortic lymph node dissection was not performed, and abdominoperineal resection comprised a one-stage pelvic floor closure. Survival was no different in the two patient populations. Extended lymphadenectomy was of no benefit in terms of survival in operated rectal cancer patients. Abdominoperineal resection may still be useful for selected patients.