First thousand rectal cancer cases--local recurrence and survival

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Rectal carcinoma necessitates surgical intervention, with various procedures including sphincter-saving procedures (SSP) and abdominoperineal resections (APR).
• The choice of surgical technique impacts patient outcomes, including local recurrence rates and long-term survival.

Purpose of the Study:

• To compare the outcomes of sphincter-saving procedures (SSP) versus abdominoperineal resections (APR) in patients with rectal carcinoma.
• To evaluate the efficacy of different mesorectal dissection techniques within SSP.

Main Methods:

• Retrospective analysis of 1095 patients who underwent curative SSP or APR for rectal carcinoma between 1990-2002.
• Categorization of SSP into high colorectal anastomosis, low anastomosis, and intersphincteric coloanal anastomosis.
• Comparison of local recurrence rates, mortality, and five-year survival between SSP and APR groups, including subgroups based on mesorectal transection technique (TME vs. transection).

Main Results:

• SSP was performed in 767 patients and APR in 328 patients. Local recurrence rates were 6.9% for SSP and 8.5% for APR. Five-year survival was 0.72 for SSP and 0.64 for APR (p < .001).
• Within the SSP group, local recurrence was 7.6% with total mesorectal excision (TME) and 5.6% with mesorectal transection. Survival was 0.75 with TME and 0.72 with transection (p < .05).
• Mortality rates were 20.1% for SSP and 24.4% for APR.

Conclusions:

• Sphincter-saving procedures (SSP) offer comparable oncological outcomes to abdominoperineal resections (APR) for rectal cancer and should be encouraged when feasible.
• Mesorectal transection is a safe and effective technique for tumors located more than 8 cm from the anal verge within the SSP approach.
• Optimizing preoperative staging and considering neoadjuvant radiotherapy may further improve outcomes in rectal cancer surgery.