Twenty-five years of experience with radical surgical treatment of carcinoma of the extraperitoneal rectum.

Between the years 1950 and 1975, 1,100 patients with carcinoma of the rectum were seen at the Toronto General Hospital. Of these, 519 had tumors below the peritoneal reflection. The resection rate in this latter group of patients was 94%. One hundred and thirty-three patients were treated by low anterior resection (LAR) and 316 by combined abdominoperineal resection (APR). Although the incidence of postoperative complications was high (LAR 41%, APR 53%), the operative mortality was low (LAR 2.2%, APR 2.9%). Recurrent tumor appeared more frequently in the pelvis (24%) than at distant sites (18%), was more common in more advanced disease, and correlated with the incidence of late death. The overall (actuarial) survival figures were 50% at 5 years and 37% at 10 years, with no significant difference between LAR and APR. For curative resections, the 5- and 10-year survival figures were 59% and 44%, respectively. Clinical staging (Dukes) influenced survival greatly, both at 5 years (Dukes A 77%, B 65%, C 33%, D 3%) and at 10 years (Dukes A 55%, B 53%, C 20%, D 0%). The level of the lesion did not influence either recurrence rate or survival.