Abdominoperineal resection: Treatment of choice for carcinoma of the rectum.

Abdominoperineal resection cure adenocarcinoma of the rectum was performed in 62 patients between 1965 and 1969 at the Winnipeg General Hospital. Mean age was 64, ranging from 41 to 83; 40 patients were male and 22 female. Distribution by Dukes' staging was: A, 11; B, 28; C, 23. Complications occurred in 22 patients (35%). Average hospital stay was 29 days, 27 days in uncomplicated patients and 36 days in those with complications. There were two deaths, a 3.2% operative mortality rate. Sixty of the 62 patients were available for 5-year followup. Crude survival rate was 52%: A, 91%; B, 59%; C, 25%. Two patients died of an operation that permanently cured three patients in whom disease had spread beyond local confines. Abdominoperineal resection offered a 52% 5-year survival rate, increased the rate of cures in the unstaged patient by at least 5% over that afforded by local therapy, gave a 14% chance of cure in stage C disease compared with 0% with local therapy, and, compared with local therapy, was at least 67% more likely to offer cure than to kill in the event of disease spread to regional lymph nodes.