Recurrence and survival after anterior resection of the rectum using the end to end anastomotic stapler

With the introduction of the end to end anastomotic stapler there has been an increase in the number of sphincter saving resections for carcinoma of the middle and distal part of the rectum. The results of earlier reports have indicated an increasing number of local recurrences possibly due to less extensive dissection of the lower pelvic area. Ninety-six patients, 46 males and 50 females, with a median age of 68 years (a range in age of 33 to 86 years) were operated upon between 1978 and 1981 for carcinoma of the rectum with anterior resection and stapled anastomosis have been analyzed. All patients were observed for more than three years (a median of 65 months and a range of 36 to 82 months). The hospital mortality rate was 5 per cent. The median distal margin was 2.5 centimeters (a range of 1 to 10 centimeters). Local recurrences occurred in 17 patients. No correlation between the grade of malignant disease and classification according to Dukes' staging and local recurrence was found. The median time between operation and the diagnosis of a local recurrence was 14 months (two to 62 months). Distant metastases developed in 14 of 83 patients who underwent operation for cure. The over-all five year survival rate was 64 per cent. The survival rate for 83 patients who underwent operation for cure was 71 per cent (96 per cent of Dukes' A, 72 per cent for Dukes' B, 45 per cent for Dukes' C and zero per cent for Dukes' D). It is concluded that the use of stapling devices has not been followed by a higher rate of local recurrence or a decreased five year survival rate and that this new technique can be used whenever technically possible.