Sphincter-saving surgery for rectal carcinoma. Comparison of two five-year periods from 1980 to 1989

The early results of treatment for rectal adenocarcinoma in 290 patients were compared in two five-year periods, from 1980 to 1989, considering sphincter preservation. Altogether, 223 patients (77%) had radical surgery and the primary tumour was excised in 267 cases (92%). Operative mortality was 2.8% (8 patients), 3.2% in the first and 2.3% in the second five-year period. Sphincter-saving surgery was undertaken in 68 of 157 patients (43%) and in 90 of 133 patients (68%) within the two periods. This failed in one (1.5%) and five (5.6%) patients (P greater than 0.05), respectively. Anastomotic leak rates were 1.4, 18 and 38% after anterior resections for tumours of the upper, middle and lower thirds of the rectum. Both mortality (1.4 vs 3.8%) and the total number of complications (23 vs 39%) were less after anterior resection than after abdominoperineal excision of the rectum. In conclusion, increased use of low anterior resection for rectal carcinoma has not led to higher mortality or overall morbidity, but the high leak rate after very low anastomoses remains to be solved.