J Korean Soc Coloproctol.  2006 Jun;22(3):177-183.

Sphincter Preserving Operation by Coloanal Anastomosis: Long Term Survival

• Lee SI
• Park YA
• Sohn SK

Abstract

PURPOSE
Abdominoperineal resection (APR) was the conventional operation for the last 100 years, however it decreased recently for the improvement of sphincter preserving operations, especially of hand-sewn coloanal anastomosis (CAA). The aim of this study is to evaluate oncological results for the CAA.
METHODS
From January 1992 to August 2000, 107 consecutive patients with rectal cancer within 7 cm from anal verge who underwent a curative resection were evaluated retrospectively by operations (APR, CAA, and stapled low anterior resection, LAR). No temporary stoma was made for CAA and LAR.
RESULTS
The mean age is 57.4 and the distance from the anal verge was 4.12 cm (+/-1.55) for 65 males and 4.13 cm (+/-1.67) for 42 females (p>0.05). The age, gender, tumor location, size, resection margin, and stage were not statistically significant according to the operations. The CAA increased from 8% (early) to 64% (late), and the APR decreased from 59% (early) to 16% (late). The 5 year survival rate was 70.1% (84.3% for Dukes B and 40.8% for Dukes C). Survivals were not statistically significant according to the type of operation. The local recurrence rate was 7.4% (13.8% for stapled low anterior resection, 7.0% for APR, and 2.8% for CAA). Of the patients with a CAA, 54% had received preoperative radiation therapy (45~55 Gy). In the late period, tumors located within 5 cm from the anal verge with fat or perirectal lymph nodes involved received preoperative radiation, and the sphincter-preserving rate was 80%.
CONCLUSIONS
CAA is an effective technique, with a safe oncologic result, for sphincter preservation in very low rectal cancer.

Keyword

Coloanal anastomosis; Low rectal cancer

MeSH Terms

Female
Humans
Lymph Nodes
Male
Rectal Neoplasms
Recurrence
Retrospective Studies
Survival Rate