ISRCTN28535118 (http://www.controlled-trials.com).

An international working party was convened in Rome, Italy on 16-17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.

The management of 115 patients with complete neoplastic obstruction of the colon was studied retrospectively. Primary resection was carried out in 40 patients, 22 with right-sided and 18 with left-sided tumours. Staged resection was planned in 48 patients and actually performed in 40. Creation of a stoma only was carried out in 25 patients because of advanced disease. There were no differences between primary and staged resection regarding the patients' general condition, concurrent disease, tumour stage according to Dukes' classification, postoperative complications, or mortality. The postoperative mortality rate was 10 per cent after primary and 15 per cent after staged resection (P not significant). The median hospital stay was 18 and 45 days, respectively. The 5-year survival rate was 38 per cent after primary and 29 per cent after staged resection. All primary resections but one were performed by qualified surgeons, while trainees created stomas as emergency treatment. The similarity in outcome suggests that in future this condition should, where possible, be treated by primary resection, by surgeons experienced in colorectal operations.

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It was more efficient, but not necessarily better, to let a specialized surgeon perform the repairs. It seems likely that targeted training in dissection and mobilization could decrease level of perceived complexity and shorten the operative time required by surgical trainees.

Four independent patient groups showed low success rates after the first plug-insertion procedure. Anterior fistulae were much less likely to heal compared with fistulae in other locations.

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