Rectal carcinoma; restorative resection using a sutured colo-anal anastomosis

Over the last forty years, rectal resection with preservation of the anal sphincters has become widely accepted as satisfactory treatment for carcinoma of the upper rectum. Tumors lower in the rectum are more difficult to treat in this way because of the difficulty of performing an anastomosis low in the pelvis. Seventy-six patients have had a rectal carcinoma resected and bowel continuity restored by means of a sutured anastomosis between colon and anal canal. Ten patients developed significant pelvic sepsis. 69 of the 70 patients whose bowel function could be assessed were either completely normal or had only minor functional defects. Four of the 39 patients who had the operation three or more years ago have developed recurrent pelvic tumor. 21 of 32 patients are alive three years and 12 of 19 are alive five years after a curative operation for rectal carcinoma. The survival rate is similar to that seen following total excision of the rectum and pelvic floor for tumors in similar sites.