The Influence of Double Stapling Technique for Distal Rectal Cancer: Oncologic and Functional Outcome

Background: The challenge of performing ultra-low anterior resection for distal rectal tumours has become technically feasible with advances in surgical technique and equipment. The double stapling technique with the linear and circular staplers is frequently favored. Aim: This study prospectively evaluates the oncologic outcome by using this technique as regards the local recurrence and overall survival alongside the associated morbidity. The functional outcome regarding continence is subjectively scored according to Kirwan scale. Material and Methods: Between the year 2002 and 2007 a total of thirty two patients were operated upon for distal rectal tumours by ultra-low anterior resection and direct anastomosis using the double stapler technique. The median distance from the dentate line was 3.5cm with a range (2-7) cm. Twenty three patients were staged (T3-4 No-1 Mo) rectal cancer underwent neo-adjuvant chemo-radiation for down-staging. Five patients were (T2 No Mo) underwent surgery. Three patients had long standing inflammatory bowel disease complicated by malignant changes in distal rectum necessi-tating total procto-colectomy with sparing a cuff of healthy mucosa above dentate line for anastomosis with ileal J pouch reconstruction and anastomosis. Protective deflating ileostomy was done routinely. Results: The overall mortality rate was nil. The 5 years actuarial survival was 77%, Local recurrence occurred in 3 patients (9.3%) with a median follow-up period of 26 months. Anastomotic leakage was detected in two patients with irradiated rectal tissue, stricture at the stapled line developed in one patient requiring frequent dilatation. The functional outcome was superior in patients with direct colo-anal anastomosis compared to those with those of J pouch anal anastomosis as regards continence and frequency. Conclusion: Double stapling technique is found to be safe and feasible for ultra-low rectal tumours with good oncologic and functional outcome.