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 20 February 2018

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Abdominoperineal resections not worse than anterior resections

Both abdominoperineal resections and sphincter-preserving anterior resections can be performed safely with low morbidity and mortality without compromising oncologic outcomes, finds the latest Diseases of the Colon & Rectum.

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Local recurrence and cure rates following abdominoperineal resections have been reported to be much worse than sphincter-preserving anterior resections.

Dr Francis Seow-Choen and colleague from Singapore evaluated the oncologic outcomes of patients treated by abdominoperineal resections.

The investigative team compared these results with those following sphincter-preserving anterior resections.

The team reviewed medical records of patients who underwent radical rectal resection for rectal carcinoma at the General Hospital from 1989 to 2002.

A total of 791 cases were studied.

The 5-year local recurrence rate was 5% for abdominoperineal resections
Diseases of the Colon & Rectum

The investigators classified operative procedures as either abdominoperineal resections or anterior resections with either straight or pouch anastomosis.

Total mesorectal excision was routinely performed for carcinomas of the lower middle and lower third of the rectum.

Sentinel events, including local and systemic recurrences or morbidity and mortality, were tracked prospectively.

The team noted that abdominoperineal resections occurred in 12%, and anterior resections with straight anastomoses in 71%.

About 17% had anterior resections with pouch anastomoses.

Postoperative mortality was 3% and postoperative morbidity was 14% with an overall anastomotic leakage rate of 3%.

The cumulative 5-year local recurrence rate was 5% for abdominoperineal resections, and 4% for anterior resections with straight anastomoses.

The investigators noted that the 5-year local recurrence rate was 4% for anterior resections with pouch anastomoses.

The median time to local recurrence also did not differ significantly between the different procedures.

Independent predictors for local recurrence included advanced tumor stage, tumor depth, and poorly differentiated tumors.

The team observed that the 5-year cancer-specific survival was 70%.

The type of anastomosis did not influence disease-free survival with median disease-free survival for patients who underwent abdominoperineal resections.

Survival for these patients was 100 months.

The team observed that survival of anterior resections with straight anastomoses was 135 months.

Survival of anterior resections with pouch anastomoses was 121 months.

The independent factors for poor survival were age greater than 65 years, advanced tumor stage, tumor depth, and poorly differentiated tumors.

Dr Seow-Choen's team commented, “Both abdominoperineal resections and sphincter-preserving anterior resections can be performed safely with low morbidity and mortality in a specialized high-volume hospital unit without compromising oncologic outcomes.”

“With appreciation of the anatomic relations in total mesorectal excision and standardized consistent surgical technique, the oncologic outcomes of patients treated by abdominoperineal resections are not worse than those treated by sphincter-preserving anterior resections.”

Dis Colon Rectum 2006: 49(1): 41-9
06 February 2006

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