Total mesorectal excision for treatment of rectal cancer

Background: This study analysed the results of treatment of rectal cancer using different surgical techniques. Methods: 264 patients who ha undergone elective curative surgical resection of rectal cancer within 12 cm of the anal verge were evaluated. Results: The overall peroperative mortality rate was nil, with morbidity of 39.4%. Local recurrence occurred in 21 of the patients. The 3-year actuarial local recurrence rates for double-stapled anastomosis, low straight anastomosis and abdominoperineal resection (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 the Knight-Griffen anastomosis (p=0.013) and tumour distance from the anal verge <6 cm (p=0.001), were associated with local recurrence, but only stage was a significant prognostic factor affecting overall survival (p=0.012). Discussion: Following total mesorectal excision, the local recurrence rate was higher in patients treated with double-stapled low anterior resection than in those with end-to-end stapled low anterior resection or APR. The cancer-specific survival rates were similar in all groups.