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Colorectal cancer ranks 3rd among all malignancies with respect to global annual incidence and mortality. In spite of increased oncidence of other sites , rectum is still the most common site of colorectal cancer. Rectal cancer is also the most challenging when it comes to performing radical surgery and achiveing optimal postoperative functional results. In recent years there have been significant changes in rectal cancer treatment strategy. Abdominoperineal recestion is being avoided with increasing frequency even in very low rectal cancer. It has been shown that even with cancer site less than 6 cm from anal verge, anterior resection and sphincter preservation could be carried out, respecting oncologic principles of rectal cancer resection. The importance of circumferential resection margin has led to development of total mesorectal excision in rectal cancer resection, with consequential lowering of local reccurence rate. Laparoscopic resection has also been established as an advantageous and safe approach to rectal cancer. We retrospectively compared patients operated for rectal cancer during 2000 and 2001 (68 cases, earlier group) with patients operated during 2004 and 2005 ( 84 cases, later group). When cancer was situated between 5 and 10 cm from anal verge , anterior resection was performed in 74% of cases in later group and in 44 % of cases in earlier group. In later group anastomosis was created using stapler in 94 % of cases, while in earlier group stapler was used in 53% of cases. Earlier and later groups did not differ significantly in respect to Dukes classification, postoperative anastomosis dehiscence, operative wound infection or postoperative mortality. In later group, in one case, laparoscopic anterior resection was successfully performed. This analysis shows that rectal cancer treatment in Clinical hospital Dubrava tends to follow global trends, although with some delay. |
