Changes in surgical approach to rectal cancer

During the past 7.5 years, 87 patients treated for colorectal adenocarcinoma at levels 20 cm and below were studied. The early group was from 1975 to 1978 and the late group from 1979 to 1983, during which time the end-to-end anastomotic stapler (EEA) was available. There were 16 low anterior resections (LAR) and 16 abdominoperineal resections (APR) performed in the early group. Thirty-five patients underwent LAR, 20 APR, and 8 EEA resections in the late group. Mean tumor levels for the early group were LAR 14.2 cm and APR 8.1 cm; late group LAR 14.9 cm, APR 5.5 cm, and EEA 8.9 cm. Mean distal margins for the early group were LAR 4.7 cm, APR 8.0 cm; late group LAR 4.5 cm, APR 6.9 cm, and EEA 2.8 cm. Complication rates in the early group were LAR 19 per cent and APR 19 per cent; late group LAR 14 per cent; APR and EEA 0 per cent. Local recurrence has occurred only in the early group; LAR 12.5 per cent and APR 19 per cent. Cumulative survival for the early group is LAR 37 per cent and APR 44 per cent; late group LAR 75 per cent, APR 58 per cent, and EEA 100 per cent. Low anterior resections can be safely performed for colorectal lesions as low as 6 cm using the EEA--with smaller margins and no compromise of recurrence or survival.