Results of treatment of distal rectal carcinoma since the introduction of total mesorectal excision: a single unit experience, 1994-2003

Background and aims: This study reviewed the results of surgery for distal rectal cancer ( where the tumour was within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. Patients and methods: One hundred and fifty-three patients who had undergone elective curative surgical resection of rectal cancer within 6 cm of the anal verge were included. The demographic, operative and follow-up data were collected retrospectively. Comparisons were made between patients who had different surgical procedures. Results: The overall operative mortality rate was nil, and the morbidity 41%. With a mean follow-up of 37 months ( range 5 - 100 months), local recurrence occurred in 18 of the patients. The 5- year actuarial local recurrence rates for double-stapled anastomosis, low-strength anastomosis and abdominoperineal resection (APR) were 39, 17 and 11% respectively. The local recurrence rate was significantly higher for double-stapled low anterior resection than for the other types of operation ( P= 0.007). On multivariate analysis type of surgery ( P= 0.025) and tumour stage ( P= 0.043), were associated with local recurrence, but only stage was a significant prognosticator of overall survival ( P= 0.0006). Conclusion: With the practice of total mesorectal excision, APR was still necessary in 40% of patients with rectal cancer within 6 cm of the anal verge. The local recurrence rate was lower in patients treated with APR than in those with double-stapled low anterior resection; however, survival rates were similar in these two groups.