Complete removal of the rectum with preservation of continence in rectal cancer
Gemsenjäger, E.; Martina, B.; Meier, A.L.
Schweizerische Medizinische Wochenschrift 114(21): 754-759
1984
ISSN/ISBN: 0036-7672 PMID: 6740293 Document Number: 222220
Restorative complete rectal excision with coloanal anastomosis was performed in 14 patients (12 cases with rectal carcinoma, i.e. 12% of a consecutive series). The pathologic stages were Dukes D in 3, Dukes C in 5, Dukes B in 2 and Dukes A in 2 patients. A simple technique of hand-sewn end-to-end endoanal anastomosis, following mobilization of the whole left colon in most cases, was employed. The postoperative course was uneventful in 11 of 14 cases, with protective colostomy in 1 patient only. 3 patients developed a presacral infection with a primary colostomy in 2 cases, and with early abdomino-perineal excision in 1 case. 1 patient with a doubtful distal margin and later recurrence refused amputation; salvage amputation became necessary in a patient with a large tumor situated 9 cm above the anocutaneous junction, who developed a locoregional recurrence by tumor implantation. Normal or satisfactory continence was recovered in all patients after a few weeks or months. Presupposing proper selection of cases and surgical technique, complete rectal excision with coloanal anastomosis is regarded as a very useful curative or palliative procedure in the treatment of rectal cancer.