• Annals of surgery · Nov 2014

    Toward the end of abdominoperineal resection for rectal cancer? An 8-year experience in 189 consecutive patients with low rectal cancer.

    • Amélie Chau, Léon Maggiori, Clotilde Debove, Frédéric Kanso, Christophe Hennequin, and Yves Panis.
    • *Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Université Denis Diderot (Paris VII), Clichy, Paris, France †Department of Radiotherapy, Service de Cancérologie et Radiothérapie, Saint Louis Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Université Denis Diderot (Paris VII), Paris, France.
    • Ann. Surg.. 2014 Nov 1;260(5):801-5; discussion 805-6.

    ObjectivesTo assess whether recent advances, such as intersphincteric resection (ISR) or local excision (LE) if a suspicion of complete tumor response after radiochemotherapy (RCT), could have modified the rate of end stoma (ES) in low rectal cancer treatment.BackgroundES rate remains around 30% to 50% in patients with low rectal cancer.MethodsFrom 2005 to 2013, all patients with low rectal cancer undergoing laparoscopic total mesorectal excision, with or without neoadjuvant RCT, and patients undergoing LE after RCT were included.ResultsA total of 189 patients presented a low rectal cancer; 162 (86%) underwent RCT; total mesorectal excision was performed in 172 (90%), followed by stapled colorectal anastomosis (n=26; 15%), manual coloanal anastomosis with partial (n=92; 53%) or total ISR (n=32; 19%), or ES that included abdominoperineal resection (n=21; 12%) and low Hartmann procedure (n=1; 1%). LE after RCT was performed in 19 of 189 (10%) patients with a suspicion of complete tumor response. Among them 2 of 19 (11%) underwent immediate secondary total mesorectal excision (1 abdominoperineal resection and 1 coloanal anastomosis with total ISR) because of poor pathological criteria.ConclusionsManagement of rectal cancer with colorectal anastomosis and coloanal anastomosis with partial ISR allowed to obtain a 38% ES rate (71/189); the additional use of total ISR decreased this rate to 22% (39/189). Selective use of LE reduced this rate to only 12% (22/189). Nowadays, recent advances lead to a paradigm shift, with only 12% ES rate in low rectal cancer.

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