[Has amputation of the rectum by pure perineal approach or Lisfranc operation still a role in the treatment of rectal cancer?].

Amputation of the rectum by a purely perineal route, the Lisfranc procedure, has been progressively replaced by abdominoperineal methods. In the AFC survey made in 1987, a Lisfranc was used only 26 times in 5,274 patients in the survey. We performed a Lisfranc 8 times from 1980 to 1993 in patients over 80 years of age or with an ASA score equal to or above 3. There was one death due to multiple-organ failure 70 days after the operation. Overall mean survival was 17.8 months and reached 24 months for those who did not have metastasis as the time of the amputation. Quality of life was assessed as good. Two patients had a local recurrence 1 and 3 years after the operation. We thus suggest that amputation of the rectum using the Lisfranc procedure can be used for certain patients in which simple colostomy (with no effect on the rectal syndrome), radiotherapy (variable and limited response), chemotherapy and other palliative procedures (electro-coagulation, laser cryosurgery) would not be indicated. Whenever tumour exeresis appears to be possible, we suggest that this method is the best palliative procedure to propose in elderly patients with several organic disorders and for cancers of the lower third of the rectum. The procedure should not however be attempted in patients with advanced stage cancer and a survival time estimated at less than 6 months.