[Anastomotic recurrence after sphincter saving resection for carcinoma of the rectum]

Between 1962 and 1982, 273 patients underwent sphincter saving resection for rectal cancer in my hospital. In 30 of these patients, local anastomotic recurrence was observed (11%). Computer analysis of 64 variables was undertaken to identify factors contributing to the anastomotic recurrence, especially in reference to the resecting line from the tumor, safety margin (AW). The present study shows no positive relationship between the length of normal bowel resected below the tumor, if it overs 2cm in advanced case, and anastomotic recurrence. We advocated the principle that "safety margin should be 4 or 5 cm in the advanced case". But this principle must now be changed. There appears every justification to carry out a curative sphincter saving procedure, resecting a shorter length of rectum -3cm (in vivo)- below the tumor in order to spare the patient a permanent colostomy. But, Borrmann 3 type, annular growth, severe serosal invasion, and undifferentiated or mucinous feature of cancer are the predominant factors associated with anastomotic recurrence and demand the longer length of safety margin as well as extended Miles operation. The causes of anastomotic recurrence in 30 patients have been investigated and searched for respectively. The recurrence in 9 of them seemed to be very unexpectedly and implantation might, therefore, be responsible for it.