The influence of type of operation for distal rectal cancer : survival, outcomes, and recurrence

Background/Aims: This study analyzed the results of treatment of rectal cancer (tumor within 12cm of the anal verge) with different techniques. Methodology: Two hundred and sixty-four patients who had undergone elective curative surgical resection of rectal cancer within 12cm of the anal verge were evaluated. The operative data and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures. Results: The overall peroperative mortality rate was nil, and the morbidity 39.4%. Local recurrence occurred in 21 of the patients with a median follow-up of 34 months (range: 5-105 months). The 3-year actuarial local recurrence rates for double-stapled anastomosis, low straight anastomosis and APR were 25%, 6%, and 5%, respectively. The local recurrence rate was significantly higher for double-stapled low anterior resection than for the other types of operation (p=0.013). On multivariate analysis reconstruction with Knight-Griffen anastomosis (P=0.013) and tumor distance from the anal verge <6cm (p=0.001), were associated with local recurrence but only stage was a significant prognosticator of overall survival (p=0.012). Conclusions: Following total mesorectal excision, the local recurrence rate was higher in patients treated with double-stapled low anterior resection than in those with termino-terminal low anterior resection or APR; survival rates were similar in these groups.