The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence.

OBJECTIVE

The most extended form of rectal resection, representing the very last option for sphincter preservation is abdomino-peranal intersphincteric resection for tumours of the lower third which otherwise would not be resectable with preservation of the sphincter by an abdominal approach alone.

PATIENTS AND METHODS

The data of 476 patients with a carcinoma in the lower third of the rectum who underwent primary treatment for stage I-III disease by low anterior resection, abdomino-peranal (intersphincteric) resection or abdominoperineal excision between 1985 and 2001 were analysed. The time periods 1985-94 and 1995-2001 were compared.

RESULTS

The rate of intersphincteric resections increased from 3% in 1985-94 to 27% in 1995-2001 while abdominoperineal excisions decreased. Postoperative complication rate was not increased in intersphincteric resections (25%) while postoperative mortality did not differ between the operative procedures. The overall 5-year-rate of locoregional recurrence decreased from 18% to 16%. In intersphincteric resections 14.2% of the patients treated with radiochemotherapy developed locoregional recurrence, while this rate was 46.5% (7/18) if adjuvant treatment was not administered (P = 0.0200). The cancer-related 5-year survival rate was not altered by intersphincteric resection.

CONCLUSION

In carcinomas of the lower third of the rectum, the application of abdomino-peranal intersphincteric resection can reduce the need for rectal excision by 20%. Neo-/adjuvant radiochemotherapy is required to reduce locoregional recurrence to an acceptable level.