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

doi:10.3393/jksc.2007.23.3.186

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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; Journal of the Korean Society of Coloproctology 2007;23(3):186-193
DOI: https://doi.org/10.3393/jksc.2007.23.3.186

¹Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine, Korea.
²Asan Medical Center, Seoul, Korea. csyu@amc.seoul.kr

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Abstract

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.

Keywords: Sphincter-saving resection;Abdominoperineal resection;Recurrence;Survival rate

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