[Limitations to the preservation of continence in rectal carcinoma]

Several reports have documented favorable results for abdominal rectal resection with coloanal anastomosis for adenocarcinoma of the rectum, though selection and the low number of patients make it difficult to compare the new restorative procedures with abdominoperineal excision. In a personal series of 35 patients treated by abdomino-transsphincteric and abdominotransanal resection, operative mortality was 2.9% and the incidence of clinically relevant pelvic sepsis was 19%. Results with respect to local control were satisfactory: in Dukes stage C (n = 12) and D (n = 4) tumors, followed up for 6 months to 9 years (mean 2.7 years), the incidence of pelvic recurrence was 19%. 3 pelvic recurrences with Dukes stage A (n = 13) or B (n = 6) tumors were observed, possibly related to operative rectal perforation in one instance and to a narrow safety margin in another patient. From this experience, and from surgical anorectal anatomy demonstrating fusion between the visceral and the somatic tube at 5 cm from the anal verge, it is concluded that proctectomy with coloanal anastomosis is a safe procedure for mid-rectum adenocarcinoma, but that a majority of low-lying cancers (greater than or equal to 6 cm ab ano) must be treated by abdominoperineal excision.