Cancer of the Rectum: The Results of Radical Resection and the Suggested Role of Lesser Procedures in Selected Cases 1

Local resection has a place in the treatment of selected patients with carcinoma of the rectum, anus and anal canal. Selection depends on the ability of the surgeon to assess accurately the stage of the tumour. Favourable lesions are those which are small, exophytic, and mobile on the surrounding tissues. A transphincteric approach has been advocated tor these tumours, but this seems unnecessarily destructive. The present series consists of 18 highly selected patients who were treated by transanal local removal. There have been two recurrences, one of which has been treated by abdominoperineal resection and the other by further local excision. All of these patients were diagnosed clinically as suffering from carcinoma before operation. Patients who had a preoperative diagnosis of carcinoma and were later found to have benign adenomas, and patients who were diagnosed as benign and later found to have histological malignancy, have been excluded.

Local Excision of Carcinomas of the Rectum, Anus, and Anal Canal

Cuthbertson

Kaye

1978

Mortality and Complications of Large‐bowel Resection for Carcinoma1

Theile

Cohen

Holt

et al. 1979

The mortallty and complications of large-bowel resection for carcinoma performed at the Princess Alexandra Hospital since the Colorectal Project commenced in 1971 are reviewed and compared with the results in other published series. There were 443 patients in this prospective study, and 375 underwent resection of their tumour. The overall operative mortality was 6.4%for colonic lesions it was 8.0% and for rectal 3.4%. The mortality for elective curative resections was Z.6%, and for emergency resections it was 10.8%. The anastomotic leak rate was 6.8%, but was higher (16.6%) when the anastomosis was done at the time of emergency resection. No patient whose anastomosis leaked but who had had a previous.defunctioning proximal colostomy died. There was a wound infection rate of 15.1%.

The Use of Radiotherapy for Pelvic Recurrence Following Abdominoperineal Resection for Carcinoma of the Rectum: A 10‐year Experience

Villalon

1981

Eighty‐five patients who developed pelvic recurrence after abdominoperineal resection for carcinoma of the rectum have been reviewed. The average period of latency was 16 months, with increasing incidence of recurrence in the more advanced stages of the disease. Eighty per cent of recurrences occurred within two years of surgical treatment and a further 20% between two and five years after operation. The prominent manifestations were pelvic pain (100%) and mass (54%), which responded to palliative radiotherapy in 92% and 80% of the cases respectively. The mean duration of palliation was 6.5 months. Patients with pelvic recurrence secondary to rectal carcinoma benefit from palliative radiation therapy, and this should be given whenever possible.