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Introduction: The results of surgical treatment of low rectal cancer ( 7 cm or less from anal verge) have been improved in the last decades, because of the availability of stapling device, the increasing use of adjuvant or neoadjuvant treatment and development of endoluminal surgery.The classical surgical technique for low rectal carcinoma, abdominoperianal amputation ( Miles operation, APA) has been gradually replaced by sphincter-saving resection (SSR). Patients and methods: A retrospective database of 210 patients who underwent surgery for rectal cancer, at Clinical Hospital Dubrava between the years 2000 and 2005 was reviewed. From number of 210 pts , 87 pts ( 41.4%) are treated due to low rectal cancer . 25 pts (28.3%) underwent SSR whereas 62 pts underwent APA. Patients who underwent SSR are treated by coloanal anastomosis (23 pts) and in two cases were performed transanal excision of tumor. From their medical chart we collected information regarding age, sex, distance of cancer from anal verge, type of operation, Dukes classification of cancer, postoperative dehiscence, operative wound infection and mortality. We compared our results, choice of resection technique and the complication after this procedure with recent literature. Results: From 25 pts 18 were male, 7 were female, medium age were 66.15 yrs (48-76).According to Dukes classification 6 patients were Dukes A , 11 patient Dukes B, 8 patients Dukes C and nil patients were Dukes D. Short-term complications occured in 4 patients, there were 3 anastomotic dechiscence, one wound dechiscence, and one lethal outcome after six days due to complication of anastomotic dechiscence. From long term complications we have uncompleted data. In five cases diverting loop ileostomy was performed , in two cases primary and secondary in three cases due to dechiscence. Conclusion: When we compare our results with recent literature we can see that despite a new trend in treatment of low rectal carcinoma we still have a small percentage of SSR especially today when tumor distance from anal verge is no longer a limit for SSR. The result which we obtain in patient who underwent SSR and postoperative complication did not differ significantly in respect to recent literature. |
