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J Korean Soc Coloproctol. 2006 Dec;22(6):396-401. Korean. Original Article.
Oh SY , Lee HW , Suh KW .
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

PURPOSE: Literature shows that low rectal cancer, that especially undergoing abdominoperineal resection (APR), is worse than mid or high rectal cancer. Two reasons have been proposed: diverse lymphatic channels in the low rectum, and technical difficulty in performing the APR. By comparison with the results reported in representative literature, we tried to find out whether low rectal cancer is really worse oncologically than high rectal cancer. METHODS: For 133 patients who underwent an APR from 1995 to 2005, we examined the pathological characteristics of the cancer, the recurrence, the metastasis, the survival rates, and the prognostic factors. RESULTS: The patient distribution according to stage was 15.9% in stage I, 33.6% in stage II, and 50.4% in stage III. The overall 5-year actuarial survival rate (5SR) of patients undergoing a curative resection (n=113) was 74.6%. Local pelvic recurrence was found in 11.5% of the patiennts, and systemic metastasis was noted in 14.2%. Among several prognostic variables, lymph node metastasis, the number of metastatic lymph nodes, adjuvant chemotherapy, and the distance between the tumor border and the dentate line were significant factors. In the multivariate analysis, lymph node metastasis was the most significant prognostic factor. CONCLUSIONS: It is true that a curative resection in low rectal cancer is difficult due to the anatomy of pelvis, so knowledge of the anatomic features of the pelvis and surgical skill are important. definitely, acceptable oncological results can be attamed if the rule of curative resection is obeyed. We also found that lymph node involvement was the most significant prognostic factor in low rectal cancer.

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