[Rectum resection with colo-anal anastomosis. Results of continence with radical surgery]

The long-term clinical and functional results of coloanal anastomosis (CAA) in the management of low and midrectal cancer were analyzed and compared with an age matched group of patients with abdomino-perineal resection (APR). Between 1977 and 1990 85 patients underwent CAA following resection for carcinomas of the mid and low rectum (67 male and 18 female, mean age 57.3 years). In 62 patients the tumor was in the lower and in 23 patients in the middle third of the rectum. A hand-sewn anastomosis was performed in 20 patients, in the 65 most recent patients the anastomosis was performed using a circular stapling instrument. No patient died as a result of pelvic sepsis. Anastomotic leakage occurred in 7% (handsewn 20%, stapled 3%), anastomotic strictures in 2.4%. 9 months after CAA complete or near complete continence was achieved by 85% of the patients. One patient was totally incontinent. More than 3 years postoperatively (1977-1987) 57 patients with curative resection could be analyzed. 39% of the patients had Dukes' A, 31% Dukes' B and 30% Dukes' C lesions. After a mean (+/- SD) length of follow-up of 6.7 years (3-13.6 years) local recurrence cumulative rates were 11% after CAA and 17% after APR, distant recurrence rates were 33% and 34% respectively. According to Dukes' stage the cancer-related 5-years survival of patients after CAA was in Dukes' A stage 88%, in Dukes' B 56%, in Dukes' C 29% and after APR 100, 53, and 22% respectively (p greater than 0.05). From these results we conclude that intersphincteric resection with CAA is a safe and efficient alternative to APR in many distal rectal carcinomas.