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

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 excisionwas 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.