Abdominosacral resection for midrectal cancer. A fifteen-year experience

From 1966 to 1981, 646 patients underwent resection for primary adenocarcinoma of the rectum by one surgeon (S.A.L.) in one hospital. The operation, selected by preoperative sigmoidoscopic measurement, was anterior resection (ASR) in 320 patients, abdominosacral resection (ASR) in 175 patients, and abdominoperineal resection (APR) in 151 patients. The operative mortality rate was 2% following each of the operations. Anastomotic complications occurred in less than 2% after AR and in 9.7% after ASR. All patients were completely continent of stool and flatus after AR and ASR. Follow-up is complete in 419 of 427 patients treated from 1966 to 1976. Five-year survival for curative resection (no distant metastases) was 66.2% after AR (129/195), 62.9% after ASR (56/89), and 43.4% after APR (33/76). For patients with no tumor in lymph nodes, survival rates were 73.9% in AR, 75% for ASR, and 59.5% for APR. With involvement of regional lymph nodes, survival fell to 45.2% in AR, 37.9% for ASR, and 17.7% for APR. Pelvic recurrence was detected in 13.3% after AR, 14.6% after ASR, and 13.2% after APR. The authors believe that for midrectal cancer, ASR is the most reliable sphincter-saving procedure. It affords maximum exposure for wide resection of the tumor and safe anastomosis without disrupting the anal sphincters and their innervation. Sphincter preservation can be consistently preserved with no apparent increase in the risk of local recurrence or death from cancer.