Annals of Coloproctology

Original Article

The Long-term Oncological Outcome of a Sphincter-saving Resection and an Abdominoperineal Resection for Lower Rectal Cancer.: Jung, Sang Hun , Yu, Chang Sik , Choi, Pyong Wha , Kim, Dae Dong , Hong, Dong Hyun , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2007;23(3):186-193.; DOI: https://doi.org/10.3393/jksc.2007.23.3.186

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Purpose
The oncological safety of a sphincter-saving resection (SSR) in lower rectal cancer is widely accepted, and both an abdominoperineal resection (APR) and a SSR are used in potentially curative surgery. This retrospective study was performed to compare the long-term oncological outcomes after an APR and a SSR in patients with lower rectal cancer (within 5 cm from the anal verge). Methods: We recruited 441 lower rectal cancer patients who underwent curative resections (APR: 305, SSR: 136) between 1995 and 2000. A total mesorectal excision and autonomic nerve preservation were routinely performed. The median follow- up period was 65 months. Results: Most demographic findings were comparable between the groups; however, the APR groups revealed more advanced pathological characteristics (tumor depth, size, cell differentiation, and metastatic LN number). The local recurrence rates after an APR and a SSR were 12.8% and 7.4%, respectively (P= 0.09). An independent risk factor of local recurrence was LN metastasis only. Distant recurrence was higher in the APR group (26.4%) than in the SSR group (13.2%), but on multivariate analysis the difference was not significant (P=0.17). The 5-year cancer-specific survival rates after an APR and a SSR were 73.2% and 87.6%, respectively (P<0.05). Particularly, there was a significant survival difference for stage III patients (APR: 59.0% vs. SSR: 83.0%, P<0.05). However, an APR was not an independent prognostic factor for cancer-specific survival in the multivariate analysis (P=0.07). Conclusions: An APR per se did not influence local recurrence after a curative resection for lower rectal cancer. The poor cancer-specific survival in the stage III APR group might be attributed to increased distant metastasis due to its more distal location.

Citations

Citations to this article as recorded by

Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer
Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim
Annals of Coloproctology.2024; 40(4): 384. CrossRef
Long-term Result for Rectal Cancer in Cases of a Curative Resection after Preoperative Chemoradiotherapy
Dong Hyun Lee, Sang Hun Jung, Jae Hwang Kim, Min Chul Shim
Journal of the Korean Society of Coloproctology.2007; 23(6): 503. CrossRef

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