Skip to main content
SpringerLink
Log in

Survival and recurrence after low anterior resection and abdominoperineal resection for rectal cancer: The results of a long-term study with a review of the literature

  • Original Articles
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Morbidity, survival, and recurrence in 203 patients treated with curative low anterior resection (LAR) were compared with those in 100 patients treated with curative abdominoperineal resection (APR). The overall 5-year survival figures for the total number of, LAR and APR patients were 75.6±5.7%, 79.8±6.4% and 67.7±9.6%, respectively. The prognosis for cancers situated low enough in the rectum to involve the anal canal was poor even when managed by APR, as evidenced by a low survival at 5 years of 59.0±9.6% and a high pelvic recurrence rate of 34%. For all except these tumors, LAR proved at least equal to, or better than APR as a curative surgical method for middle and low rectal cancers, on the basis of 5-year survival being 79.8±6.4% vs 78.7±5.2%, operative mortality being 1.5% vs 1.0%, morbidity being 39.4% vs 59.0%, and the incidence of pelvic recurrence being 8.9% vs 13.5%. When deciding upon the most appropriate surgical procedure for rectal cancer, especially for middle or low rectal lesions, the patient should not simply be condemned to a permanent colostomy. Thus, we first attempt LAR for every lesion except those which are very advanced or those with anal canal involvement, if technically feasible and suitable for the individual patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Fain SN, Patin CS, Morgenstern L (1975) Use of a mechanical suturing apparatus in low colorectal anastomosis. Arch Surg 110:1079–1082

    Google Scholar 

  2. Goligher JC, Lee PWR, Macfie J, Simpkins KC, Lintott DJ (1979) Experience with the Russian model 249 suture gun for anastomosis of the rectum. Surg Gynecol Obstet 148:517–524

    Google Scholar 

  3. Buckspan RJ, Sawyers JL (1985) Changes in surgical approach to rectal cancer. Am Surg 51:21–25

    Google Scholar 

  4. Odou MW, O'Connell TX (1986) Changes in the treatment of rectal carcinoma and effects on local recurrence. Arch Surg 121:1114–1116

    Google Scholar 

  5. Jinnai D (1983) General rules for clinical and pathological studies on cancer of the colon, rectum, and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 13:557–573

    Google Scholar 

  6. Culter SJ, Ederer F (1958) Maximum utilization of the life table method in analyzing survival. J Chron Dis 8:699–712

    Google Scholar 

  7. Dukes CE (1932) The classification of cancer of the rectum. J Pathol Bacteriol 35:323–332

    Google Scholar 

  8. Jinnai D (1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part II. Histopathological classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 13:574–598

    Google Scholar 

  9. Broders AC (1926) Carcinoma grading and practical applications. Arch Pathol 2:376

    Google Scholar 

  10. Morson BC, Vaughan EG, Bussey HJR (1963) Pelvic recurrence after excision of rectum for carcinoma. Br Med J 2:13–18

    Google Scholar 

  11. Labow SB, Salvati EP, Rubin RJ (1975) Suture-line recurrence in carcinoma of the colon and rectum. Dis Colon Rectum 18:123–125

    Google Scholar 

  12. Leff EI, Shaver JO, Hoexter B, Labow S, Moseson MD, Goldstein SD, Rubin RJ, Eisenstat TE, Salvati EP (1985) Anastomotic recurrences after low anterior resection. Stapled vs. hand-sewn. Dis Colon Rectum 28:164–167

    Google Scholar 

  13. Colombo PL, Foglieni CLS, Morone C (1987) Analysis of recurrence following curative low anterior resection and stapled anastomoses for carcinoma of the middle third and lower rectum. Dis Colon Rectum 30:457–464

    Google Scholar 

  14. Goligher JC, Dukes CE, Bussey HJR (1951) Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg 39:199–211

    Google Scholar 

  15. Wolmark N, Fisher B (1986) An analysis of survival and treatment failure following abdominoperineal and sphincter-saving resection in Dukes' B and C rectal carcinoma. A report of the NSABP clinical trials. Ann Surg 204:480–489

    Google Scholar 

  16. Wolmark N, Gordon PH, Fisher B, Weiand S, Lerner H, Lawrence W, Shibata H (1986) A comparison of stapled and hand-sewn anastomoses in patients undergoing resection for Dukes' B and C colorectal cancer: An analysis of disease-free survival and survival from the NSABP prospective clinical trial. Dis Colon Rectum 29:344–350

    Google Scholar 

  17. Kirwan WO, Drumm J, Hogan JM, Keohane C (1988) Determining safe margin of resection in low anterior resection for rectal cancer. Br J Surg 75:720

    Google Scholar 

  18. Thomas GDH, Dixon MF, Smeeton NC, Williams NS (1983) Observer variation in the histological grading of rectal carcinoma. J Clin Pathol 36:385–391

    Google Scholar 

  19. Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery — the clue to pelvic recurrence? Br J Surg 69:613–616

    Google Scholar 

  20. Enker WE, Heilweil ML, Hertz RL, Pilipshen SJ, Stearns Jr MW, Sternberg SS, Janov AJ (1986) En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer. Ann Surg 426–433

  21. Deddish MR, Stearns Jr MW (1961) Anterior resection for carcinoma of the rectum and rectosigmoid area. Ann Surg 154:961–966

    Google Scholar 

  22. Slanetz Jr CA, Herter FP, Grinnel RS (1972) Anterior resection versus abdominoperineal resection for cancer of the rectum and rectosigmoid. Am J Surg 123:110–117

    Google Scholar 

  23. Strauss RJ, Friedman M, Platt N, Wise L (1978) Surgical treatment of rectal carcinoma: Results of anterior resection vs. abdominoperineal resection at a community hospital. Dis Colon Rectum 21:269–276

    Google Scholar 

  24. Patel SC, Tovee EB, Langer B (1977) Twenty-five years of experience with radical surgical treatment of carcinoma of the extraperitoneal rectum. Surgery 82:460–465

    Google Scholar 

  25. Stearns Jr MW (1974) The choice among anterior resection, the pull-through, and abdominoperineal resection of the rectum. Cancer 34:969–971

    Google Scholar 

  26. Whittaker M, Goligher JC (1976) The prognosis after surgical treatment for carcinoma of the rectum. Br J Surg 63:384–388

    Google Scholar 

  27. Minsky BD, Mies C, Recht A, Rich TA, Chaffey JT (1988) Resectable adenocarcinoma of the rectosigmoid and rectum. I. Patterns of failure and survival. Cancer 61:1408–1416

    Google Scholar 

  28. Stearns Jr MW, Deddish MR (1956) The influence of size on prognosis of operable cancer of the rectum and distal sigmoid. Cancer 9:139–140

    Google Scholar 

  29. Nicholls RJ, Ritchie JK, Wadsworth J, Parks AG (1979) Total excision or restorative resection for carcinoma of the middle third of the rectum. Br J Surg 66:625–627

    Google Scholar 

  30. Williams NS, Johnston D (1984) Survival and recurrence after sphincter-saving resection and abdominoperineal resection for carcinoma of the middle third of the rectum. Br J Surg 71:278–282

    Google Scholar 

  31. McDermott F, Hughes Sr E, Pihl E, Milne BJ, Price A (1982) Long term results of restorative resection and total excision for carcinoma of the middle third of the rectum. Surg Gynecol Obstet 154:833–837

    Google Scholar 

  32. Williams NS, Durdey P, Johnston D (1985) The outcome following sphincter-saving resection and abdominoperineal resection for low rectal cancer. Br J Surg 72:595–598

    Google Scholar 

  33. Pilipshen SJ, Heiweil M, Quan SHQ, Sternberg SS, Enker WE (1984) Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 53:1354–1362

    Google Scholar 

  34. Luke M, Kirkegaard P, Lendorf A, Christiansen J (1983) Pelvic recurrence rate after abdominoperineal resection and low anterior resection for rectal cancer before and after introduction of the stapling technique. World J Surg 7:616–619

    Google Scholar 

  35. Phillips RKS, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following “curative” surgery for large bowel cancer: II. The rectum and rectosigmoid. Br J Surg 71:17–20

    Google Scholar 

  36. Pollett WG, Nicholls RJ (1983) The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 198:159–163

    Google Scholar 

  37. Enker WE, Laffer UTh, Block GE (1979) Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 190:350–360

    Google Scholar 

  38. Anderberg B, Enblad P, Sjodahl R, Wetterfors (1983) The EEA-stapling device in anterior resection for carcinoma of the rectum. Acta Chir Scand 149:99–103

    Google Scholar 

  39. Reid JDS, Robins RE, Atkinson KG. Pelvic recurrence after anterior resection and EEA stapling anastomosis for potentially curable carcinoma of the rectum. Am J Surg 147:629–632

  40. Quer EA, Dahlin DC, Mayo CW (1953) Retrograde intramural spread of carcinoma of the rectum and rectosigmoid: A microscopic study. Surg Gynecol Obstet 96:24–30

    Google Scholar 

  41. Grinnell RS (1954) Distal intramural spread of carcinoma of the rectum and rectosigmoid. Surg Gynecol Obstet 99:421–430

    Google Scholar 

  42. Goligher JC (1975) Treatment of carcinoma of the rectum. In: Goliger JC (eds) Surgery of the anus, rectum and colon, 3rd edn. Bailliere Tindall, London, pp 661–662

    Google Scholar 

  43. Hughes TG, Jenevein EP, Poulos E (1983) Intramural spread of colon carcinoma: A pathologic study. Am J Surg 146:697–699

    Google Scholar 

  44. Williams NS, Dixon MF, Johnston D (1983) Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: A study of distal intramural spread and of patients' survival. Br J Surg 70:150–154

    Google Scholar 

  45. Wilson SM, Beahrs OH (1976) The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. Ann Surg 183:556–565

    Google Scholar 

  46. Christiansen J (1983) Place of abdominoperineal excision in rectal cancer. J Roy Soc Med 81:143–145

    Google Scholar 

  47. Schaeffer CJ, Giordano JM (1981) Complications associated with EEA stapler in performance of low anterior resections. Am Surg 47:426–428

    Google Scholar 

  48. Cade D, Gallagher P, Schofield PF, Turner L (1981) Complications of anterior resection of the rectum using the EEA stapling device. Br J Surg 68:339–340

    Google Scholar 

  49. Heald RJ, Chir M, Leicester RJ (1981) The low stapled anastomosis. Dis Colon Rectum 24:437–444

    Google Scholar 

  50. Leff EI, Hoexter B, Labow SB, Eisenstat TE, Rubin RJ, Salvati EP (1982) The EEA stapler in low colorectal anastomoses: Initial experience. Dis Colon Rectum 25:704–707

    Google Scholar 

  51. Zollinger RM, Sheppard MH (1971) Carcinoma of the rectum and the rectosigmoid: A review of 729 cases. Arch Surg 102:335–338

    Google Scholar 

  52. Lockhart-Mummery HE, Ritchie JK, Hawley PR (1976) The results of surgical treatment for carcinoma of the rectum at St Mark's Hospital from 1948 to 1972. Br J Surg 63:673–677

    Google Scholar 

  53. Jones PF, Thomson HJ (1982) Long term results of a consistent policy of sphincter preservation in the treatment of carcinoma of the rectum. Br J Surg 69:564–568

    Google Scholar 

  54. Michelassi F, Block GE, Vannucci L, Montag A, Chappell R (1988) A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma. Ann Surg 208:379–389

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Department of Surgery, Hirosaki University School of Medicine, 5-Zaifu-cho, 036, Hirosaki, Japan

    Mitsuru Konn, Takayuki Morita, Ryukichi Hada, Yuji Yamanaka, Mutsuo Sasaki, Hirohumi Munakata, Hidetoshi Suzuki, Shigeaki Inoue, Masaaki Endoh, Yuzuru Sugiyama & Keiichi Ono

Authors
  1. Mitsuru Konn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryukichi Hada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuji Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mutsuo Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirohumi Munakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hidetoshi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shigeaki Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masaaki Endoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yuzuru Sugiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Keiichi Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Konn, M., Morita, T., Hada, R. et al. Survival and recurrence after low anterior resection and abdominoperineal resection for rectal cancer: The results of a long-term study with a review of the literature. Surg Today 23, 21–30 (1993). https://doi.org/10.1007/BF00308995

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00308995

Key Words

Search

Navigation