[Rectal cancer--results of continence-preserving resections]

In a series of 586 patients with rectal carcinoma who underwent potentially curative resection between January 1977 and December 1990 postoperative complications, incidence of local recurrence and disease free survival are investigated. Of the 401 patients undergoing low anterior resection (LAR) and 89 patients with coloanal anastomosis (CAA) 389 anastomoses were fashioned with staples. The hospital mortality rate was 4.6%. Clinical anastomotic leakage occurred in 5.5% (handsewn 10.3% stapled 4.3% (p less than 0.05), anastomotic strictures in 7.5% and 2.4% (p less than 0.05). 20% of patients undergoing restaurative resection (RR) (handsewn 23%, stapled 20%) developed local recurrences compared with 21% for the group with abdominoperineal resection (APR). The corrected 5-year survival rate was 63% for RR respectively 55% for APR (p greater than 0.05). After CAA, incidence of local recurrence and survival rate for patients with carcinoma of the lower rectum was 11% respectively 63%. It is concluded that innovative advances like the development of circular stapling devices and the adoption of a more aggressive sphincter-saving policy like CAA cause not an increased risk of recurrent diseases and no decrease of the 5-year survival rate.