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Chirurgia 1999 April;12(2):111-8

language: Italian

Local control of disease after curative surgery for cancer of the extraperitoneal rectum

Secco G. B., Fardelli R., Davini M. D., Bonfante P., Baldi E., Canaletti M., Fornaro R., Ferraris R.


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Background. In the surgical treatment of rectal cancer, abdominoperineal resection (APR) and anterior resection are procedures that ensure comparable local control of the disease and long-term survival. Local control of disease after low anterior resection (LAR) of neoplasms of the extraperitoneal rectum is still a controversial question.
Methods. A retrospective study was carried out in 264 patients with low rectal cancer surgically treated from January 1975 to December 1995 in order to analyze the influence of stapling devices on surgical behaviour and disease outcome. Patients were classified as follows: Group 1: who underwent surgery from 1975 to 1980, when staplers were not employed and Group 2, who underwent surgery from 1981 to 1995, when stapling devices were routinely used.
Results. The use of stapling devices led to a corresponding increase in LAR and remarkable decrease in postoperative mortality. In patients treated with APR an improved local control compared to LAR was observed. A statistically significant difference in local recurrence rate between APR patients and LAR cases of Group 1 was also observed. In T3, N+ cases there was no statistically significant difference in local recurrence rate between APR patients and LAR cases with stapled anastomosis. Improved local control occurred in stapled Group 2 patients which was indipendent of the distal clearance.
Conclusions. Results indicated that a similar outcome after APR and LAR with stapled anastomosis can be also expected in locally advanced carcinoma of the distal rectum.

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