Results of radical surgery for rectal cancer (original) (raw)

1992, World Journal of Surgery

Abstract

This paper examines the hypothesis that a reduction in the distal mural margin during anterior resection for sphincter conservation in rectal cancer excision is safe, provided total mesorectal excision is undertaken with wash-out of the clamped rectum. One hundred ninety-two patients underwent anterior resection and 21 (<10%) patients underwent abdomino-perineal excision (APE) by one surgeon (RJH). Anterior resections were classified as "curative" (79%) and "non-curative" (21%); in the "curative" sub-group <4% of patients developed local recurrence. The series was retrospectively analyzed for the effect of mural margins on local recurrence with 152 patients undergoing "curative" anterior resections and 40 patients undergoing "non-curative" resections. In the 152 specimens from curative resections, 110 had a resection margin >1 cm and 42 had a resection margin <1 cm. Four patients developed local recurrence in the >1 cm margin group (95% confidence interval: 0.8%-7.8%) and no patients developed local recurrence in the <1 em margin group (95% confidence interval: 0%-5.9%). In each patient with local recurrence a cause for failure was apparent. There was no statistically significant difference in local recurrence rate between the -<1 cm margin group and the >1 cm margin group. A reduction in resection margin therefore did not compromise survival after anterior resection.

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