[Sphincter saving procedure for low rectal carcinoma]

Sphincter saving procedure (SSP) was applied when, for tumor which were a localized type and well or moderate differentiated adenocarcinoma, distal clearance margin (AW) more than 2 cm was obtained and when, for tumor which was a infiltrated type or adenocarcinoma with other pathological grades, AW more than 3 cm was obtained. Between 1984 and 1993, 209 patients with rectal carcinomas, the lower border of which was located below the peritoneal reflexion, underwent curative surgery: SSP in 114 and abdominoperineal resection (APR) in 95. The APR group included more advanced cases both in the depth of invasion and in lymph node metastases (p = 0.011, p = 0.059, respectively). During the median follow-up of 68.6 months, recurrent tumors were developed in 17.5% of the SSP and in 30.5% of the APR (p = 0.027). The patients with SSP showed better prognosis than those with APR(p = 0.0007), with the 5 year survival rate of 80.2% and 70.0%, respectively. The difference may be due to higher incidence of hematogenous metastases in the APR (26.3%) than in the SSP (13.2%). There was no difference in local recurrences between them. When function after SSP was compared with that after anterior resection for middle or upper rectal carcinomas, no difference was observed between them, although most patients of the both groups complained of increased frequency of defecation and occasional soiling. The criteria of SSP for low located rectal carcinoma may be adequate with the acceptable oncological outcome, but altered function after SSP should be improved.