Analysis of recurrence following curative low anterior resection and stapled anastomoses for carcinoma of the middle third and lower rectum.

In a series of 93 patients with middle and lower rectal cancer, who underwent potentially curative surgery by low anterior resection (LAR) with EEA stapled anastomosis or by abdominoperineal excision (APE) between January 1977 and December 1981, the incidence of recurrence and survival rate was compared. LAR with stapler was performed in 61 patients: 55 (90.2 percent) with tumors of the middle third and six (9.8 percent) for tumors of the lower third of the rectum. APE was performed in 32 patients: 13 (40.6 percent) with cancer of the midrectum and 19 (59.4 percent) of the lower rectum. Tumor site, Dukes' distribution, grade of malignancy, and extent of local spread were recorded. The tumor stages for LAR with stapler and for APE, respectively, were Dukes' A 7/1; Dukes' B 27/10; Dukes' C 25/18; Dukes' D 2/3. In a follow-up period of four years (range, 6 to 52 months) the overall recurrence rates were 20.4 percent in the LAR with stapled anastomosis group and 21 percent in the APE group. Local recurrence percentages were 9.8 percent after LAR and 14 percent after APE (P = N.S.). Distant recurrences were 12 percent and 14 percent, respectively. The four-year overall survival rates were 76.7 percent after LAR and 65.5 percent after APE (P = N.S.) The clinical and pathologic factors correlated with recurrence in low rectal carcinoma were reanalyzed and the controversial points of the surgical management for and against LAR with stapled anastomosis and APE were discussed. It is concluded that LAR with the EEA stapler can be carried out in the middle and lower rectum with the prospect of ultimate cure, when performed with proper technical skills in selected patients.