[Limited indications for posterior rectotomy. Results of a series of 42 cases]

Forty-two mobile tumours on digital rectal examination were excised by posterior rectotomy: via a transsphincteric approach in 16 cases and via a pararectal suprasphincteric approach in 26 cases; 3 primary protective colostomies were performed. Nineteen tubulovillous adenomas and 23 carcinomas were excised. The excision included the entire thickness of the rectal wall in the form of resection-anastomosis (n = 10) or a disk resection (n = 32). This series consisted of 27 males and 15 females between the ages of 42 and 92 years (mean = 70 years). The definitive histology revealed 12 T1 tumours, 7 T2 tumours and 3 T3 tumours. There were two postoperative deaths. The remaining patients have a mean postoperative follow-up of 45 months. 2/16 (12.5%) local recurrences occurred in the group of tubulovillous adenomas and 2 local recurrences with distant metastases were observed in the carcinoma group, while 3 patients only developed distant metastases. The cancer-related mortality was 5/21 (23.89%). Disturbances of continence persisted in 6/29 surviving patients, 4 patients complained of urgent defecation, 1 of uncontrolled passage of gas and a single patient had persistent incontinence of liquid stools. Posterior rectotomy allows excision of extensive tubulovillous adenomas and local recurrences are less frequent than after transanal excision and are similar to the results obtained with transabdominal rectal resections. The operative mortality was lower than that of laparotomy. Posterior rectotomy allows adequate resection of localised carcinomas (T1) with no lymph node involvement. The statistical frequency of lymph node metastases in stage T2 and T3 tumours only justifies the use of this technique when the patient refuse colostomy, has an excessively high risk to undergo laparotomy or when the operation is purely designed to be palliative. The disturbances of continence observed were minor and only slightly disabling.