Abstracts
2000 Digestive Disease Week

# 2247 Surgical Treatment of Distal Third Rectal Carcinoma: Oncologic Outcome Following Rectal Excision with Coloanal Anastomosis
Versus Abdominal Perineal Resection. Reza A. Gamagami, Sarhang Mohammed, Arnaud Liagre, Franck Lazorthes, San Diego, CA, Toulouse, France

The standard surgical treatment of patients with distal third rectal cancer has remained abdominal perineal resection (APR). The high pelvic recurrence rate and compromising cure have served as arguments against sphincter saving resections (SSR). In this prospective case-control study, we compare survival and local recurrence rates for patients with cancers of the lower third of the rectum (4-7cm from the anal verge) treated, by abdominal perineal resection (APR) versus rectal excision with coloanal anastomosis. Between 1977 and 1993, 620 rectal excisions were performed for rectal adenocarcinoma. 320 were for distal third rectal adenocarcinomas. In order to eliminate, selection bias two separate periods were identified when either only rectal excision and coloanal anastomosis (sphincter preservation) or abdominal perineal resections were being exclusively performed. The 2 groups were matched for sex, age, stage, and adjuvant therapy. From 1977 to 1983, 33 patients were treated by abdominal perineal resection. They were compared to another 34 patients who were treated by curative abdomino trans-sphincteric resection, from 1988-1993. There was no postoperative death. Patients were followed for a mean of 4.8 years after SSR and 5.5 after APR. At 5 years actuarial local recurrence rates were 6.5% and 15% for SSR and APR respectively. The cancer specific 5 year actuarial rates were 77.4 and 73.5 for APR and SSR respectively. Sphincter saving resection does not seem to compromise local recurrence or survival for patients with tumors located in the distal third of the rectum.