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Abdominoperineal Excision of the Rectum -
an endangered operation |
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Purpose: This study was undertaken
to test the efficacy of an extreme policy of sphincter conservation by combining precise
total mesorectal excision with low stapling techniques and endoluminal lavage to guard
against implanantions. |
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Methods: A total of 136 consecutive
operations for cancer below 5 cm from the anal verge has been prospectively documented and
followed for a mean of 7.7 (range, 1-18) years. A total of 105 of the operations
were anterior resections (77 percent), and 31 were abdominoperineal excisions (23
percent). |
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Results: The oncologic results in
the 105 patients who underwent anterior resections appear greatly superior to those of the
patients who underwent abdominoperineal excisions, although the number of abdominoperineal
excisions was small (31). Actuarial local recurrence at six years for anterior
resection and total mesorectal excision was 1 percent for 85 curative procedures and 4
percent for all cases (n=100), compared with 33 and 47 percent for abdominoperineal
excisions (n=15 and 31). Only four recurrences were observed below the level of the
levators, three in the wound of an abdominoperineal excision and one in a stapled
anastomosis after a palliative excision. No cases of nodal metastasis in the
ischiorectal fossa were observed. |
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Conclusion: In a unit specializing
in sphincter conservation, precise total mesorectal excision from above appears
oncologically superior to abdominoperineal excision. Three-fourths of patients with
carcinoma of the lower one-third of the rectum can be offered sphincter-conserving
surgery, although temporary defunctioning is probably prudent in such cases. The
wound of an abdominoperineal excision may be a prerequisite for perineal recurrence, which
may often be caused by implantation. |
