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Low rectal cancer--what is the choice?
G Fegiz1, M Indinnimeo, P Gozzo
1I Institute of Surgical Clinic, University La Sapienza, Rome, Italy.
Diseases of the Colon and Rectum
|February 1, 1994
Summary
Recurrence in low rectal cancer depends on tumor characteristics, not surgical method. Early detection through intensive follow-up aids reoperation for better outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Evaluating surgical outcomes for low rectal cancer is crucial for patient prognosis.
- Pathologic features are increasingly recognized as key indicators of cancer recurrence risk.
- Understanding factors influencing recurrence and functional results guides treatment decisions.
Purpose of the Study:
- To assess functional results, recurrence rates, and survival based on surgical approach for low rectal cancer.
- To identify pathologic risk factors associated with disease recurrence.
- To analyze the impact of surgical margins on anastomotic recurrence.
Main Methods:
- Retrospective analysis of 131 patients with low rectal cancer undergoing anterior resection, abdominoperineal resection, or local treatment.
- Detailed examination of pathologic features (tumor diameter, infiltration, differentiation) as potential recurrence predictors.
- Follow-up ranging from 12 to 84 months to monitor recurrence and functional outcomes.
Main Results:
- Abdominoperineal resection was associated with more advanced disease; anterior resection had a 2.1% postoperative mortality.
- Recurrence rates were 53.3% for abdominoperineal resection and 28.9% for anterior resection.
- Recurrence was linked to tumor size (>5 cm), infiltration, lymphangitis, and poor differentiation, not the surgical technique itself. Anastomotic recurrence occurred in 28.6% with margins <2 cm.
Conclusions:
- Tumor pathology, rather than surgical type, is the primary determinant of recurrence in low rectal cancer.
- Intensive follow-up facilitates early detection of anastomotic recurrence, enabling timely reoperation.
- Anterior resection demonstrated encouraging functional results with no severe incontinence reported; local treatment was effective in select early-stage cases.