Toward the end of abdominoperineal resection for rectal cancer? An 8-year experience in 189 consecutive patients with low rectal cancer.

  • Chau A
  • Maggiori L
  • Debove C
 et al. 
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Abstract

OBJECTIVES: To assess whether recent advances, such as intersphincteric resection (ISR) or local excision (LE) if a suspicion of complete tumor response after radiochemotherapy (RCT), could have modified the rate of end stoma (ES) in low rectal cancer treatment. BACKGROUND: ES rate remains around 30% to 50% in patients with low rectal cancer. METHODS: From 2005 to 2013, all patients with low rectal cancer undergoing laparoscopic total mesorectal excision, with or without neoadjuvant RCT, and patients undergoing LE after RCT were included. RESULTS: A total of 189 patients presented a low rectal cancer; 162 (86%) underwent RCT; total mesorectal excision was performed in 172 (90%), followed by stapled colorectal anastomosis (n=26; 15%), manual coloanal anastomosis with partial (n=92; 53%) or total ISR (n=32; 19%), or ES that included abdominoperineal resection (n=21; 12%) and low Hartmann procedure (n=1; 1%). LE after RCT was performed in 19 of 189 (10%) patients with a suspicion of complete tumor response. Among them 2 of 19 (11%) underwent immediate secondary total mesorectal excision (1 abdominoperineal resection and 1 coloanal anastomosis with total ISR) because of poor pathological criteria. CONCLUSIONS: Management of rectal cancer with colorectal anastomosis and coloanal anastomosis with partial ISR allowed to obtain a 38% ES rate (71/189); the additional use of total ISR decreased this rate to 22% (39/189). Selective use of LE reduced this rate to only 12% (22/189). Nowadays, recent advances lead to a paradigm shift, with only 12% ES rate in low rectal cancer.

Author-supplied keywords

  • Adenocarcinoma
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical
  • Chemoradiotherapy
  • Digestive System Surgical Procedures
  • Female
  • Humans
  • Ileostomy
  • Laparoscopy
  • Male
  • Microsurgery
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Perineum
  • Rectal Neoplasms
  • Treatment Outcome
  • methods
  • pathology
  • surgery
  • therapy

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Authors

  • Amelie Chau

  • Leon Maggiori

  • Clotilde Debove

  • Frederic Kanso

  • Christophe Hennequin

  • Yves Panis

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