The Outcome of Sphincter-Saving Resection and Abdomino-Perineal Resection for Distal Rectal Cancer

Background: The advent of surgical techniques has enabled more patients with mid and low rectal cancer to have sphincter saving resections (SSR). This procedure, however has provoked doubts regarding the adequacy of resection and fear of in¬creased rates of recurrence compared with Abdomino-perineal resection (APR). The introduction of Total Mesorectal Excision (TME) has much lowered the recurrence rate to nearly 4%.Objective: This study was performed to compare the oncological results of SSR for low and mid rectal cancer patients with those obtained APR before that period.Material and Methods: A total of one hundred and fifteen patients (115) were enrolled in this study. The tumours were located between 3-12cm from anal verge. Fifty one patients (45%) underwent SSR between the years 2002-2007.The incidence of recurrence after radical SSR was compared with the historical control group of sixty patients (52%) which underwent APR. The two groups being matched for Duke s stage and tumour location. Four patients had local treatment.Results: The mean follow-up period of patients was 2.3 years, range (1-5) years.After 2 years follow-up, the local recurrence cumulative rate was 10.3% after SSR and 16.5% after APR. Distant recurrence rates were 15% and 20% respectively.Six patients (12%) died of their disease within 2 years of radical SSR, nine patients (15%) after radical APR.The overall 5 years actuarial survival in the SSR group was 70.2% compared to 64% in the retrospective matched control group who underwent APR.Conclusion: SSR for mid and low rectal tumours appears to have a superior outcome over APR since there is no risk of increased recurrent disease compared to APR after an equivalent follow-up period.