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THE SKILLFUL SCALPEL: Original Article
doi:
10.4103/2278-330X.119929
Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir
1
Department of General and Minimal Access Surgery, Colorectal Division, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
2
Department of Otorhinolaryngology, SMHS Hospital, Srinagar, Jammu and Kashmir
3
Department of Internal Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
*Corresponding author: Dr. Shabeer Ahmad Mir. drshabeerahmad@gmail.com
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Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Summary and Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. Objectives: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. Materials and Methods: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. Results: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. Conclusion: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results.
Keywords
References
- American Cancer Society (2011). Cancer Facts and Figures 2011. Atlanta, GA: American Cancer Society; 2011.
- Sato H, Malsumoto M, Aoyama H. Modified double stapling technique in Low Ant. Resection for low rectal carcinoma. J Surg Today 2006;36:30-6.
- Vauthey JN, Marsh RW, Zlotecki RA, Abdalla EK, Solorzano CC, Bray EJ, et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg 1999;228:745-54.
- Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer. The Basingstoke experience of total mesorectal excision 1978-1997. Arch Surg 1998;1333;894-9.
- Stearns MW Jr. The choice among anterior resection, the pull-through, and abdominoperineal resection of the rectum. Cancer 1974;34:969-71.
- Kirwan WO, Turnbull RB Jr, Fazio VW, Weakly FL. Pull-through operation with delayed anastomosis for rectal cancer. Br J Surg 1978;65:695-8.
- Cagir B, Harris JE, Douglas RT. Rectal cancer treatment and management. Nov 11, 2011.
- Killingback MK. Quoted by Mc Dermott FT. carcinoma of the rectum. In: Hughes ES, Cuthbertson AM, Killingback MK, editors. Colorectal surgery. Melbourne: Churchill Livingstone; 1983. p. 377-9
- Enker WE, Stearns MW, Janov AL. Peranal coloanal anastomosis following low anterior resection for rectal carcinoma discolon rectum 1985;28:575-81.
- van Helmond J, Beart RW. Cancer of the rectum: Operative management and adjuvant therapy. In: Current Therapy in Colon and Rectal Surgery. 2nd ed. Philadelphia, Pa: Mosby; 2005.
- Lacalio-Mummery HE, Coppa GF. Abdominosacral resection for midrectal cancer. Ann Surg 1983;198:320-4.
- Nicholls RJ, Ritchie JK, Wadsworth J, Parks AG. Total excision or restorative resection for carcinoma of middle third of rectum Br J Surg 1979;66:625-7.
- Shrikhande SV, Saoji RR, Barreto SG, Kakade AC, Waterford SD, Ahire SB, et al. Outcomes of resection for rectal cancer in India: The impact of the double stapling technique. World J Surg Oncol 2007;5:35.
- Goligher JC. Current trends in use of sphincter saving excision in the treatment of carcinoma of the rectum. Cancer 1982;50:2627-30.
- Baran JJ, Goldstein SD, Resnik AM. The double-stapling technique in colorectal anastomosis. Am Surg 1992;58:270-2.
- Moran BJ, Blenkinsop J, Finnis D. Local recurrence after anterior resection for rectal cancer using a double stapling technique. Br J Surg 1992;79:836-8.
- Redmond HP, Austin OM, Clery AP, Deasy JM. Safety of double-stapled anastomosis in low anterior resection. Br J Surg 1993;80:924-7.
- Laxamana A, Solomon MJ, Cohen Z, Feinberg SM, Stern HS, McLeod RS. Long-term results of anterior resection using the double-stapling technique. Dis Colon Rectum 1995;38:1246-50.
- Kanellos I, Vasiliadis K, Angelopoulos S, Tsachalis T, Pramateftakis MG, Mantzoros I, et al. Anastomotic leakage following anterior resection for rectal cancer. Tech Coloproctol 2004;8(Suppl 1):s79-81.
- Lockhart-Mummery HE, Ritchie JK, Hawley PR. The results of surgical treatment for carcinoma of rectum at St. Marks Hospital from 1948 to 1972. Br J Surg 1976;63:673-7.
- Waugh JM, Block MA, Gage RP. Three and five year survivals following combined abdominoperineal resection, abdominoperineal resection with sphincter preservation and anterior resection for carcinoma of the rectum and lower part of sigmoid colon. Ann Surg 1955;142:752-7.
- Waugh JM, Turner JC. A study of 268 patients with carcinoma of middle rectum treated by abdominoperineal resection with sphincter preservation. Surg Gynecol Obstet 1958;102:777-83.
- Wilson SM, Beahrs OH. The curative treatment of carcinoma of the sigmoid, rectosigmoid and rectum. Ann Surg 1976;181:556-65.
- Williams NS, Johnston D, Survival and recurrence after sphincter saving resection and abdominoperineal resection for carcinoma of the middle third of rectum. Br J Surg 1984;71:278-82.
- Goligher JC. Use of circular stapling gun with peranal insertion of anorectal purse-string suture for construction of very low colorectal or coloanal anastomosis. Br J Surg 1979;66:501-4.
- Localio A, Eng K. Sphincter- saving operations for cancer of the rectum. N Engl J Med 1979;300:1028-30.
- Nicholls RJ. Rectal cancer: Anterior resection with per anal coloanal anastomosis. Bull Cancer 1983;70:304-7.
- Parks AG, Percy JP. Rectal carcinoma: Restorative resection using a sutured colo-anal anastomosis. Int Surg 1983;68:7-11.
- Suzuki H, Mutsumoto K, Fujioka M, Honzumi M. Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 1980; 67:655-7.
- Rouanet P, Fabre JM, Dubois JB, Dravet F, Saint Aubert B, Pradel J, et al. Conservative surgery for low rectal carcinoma after high dose radiation-functional and oncological results. Ann Surg 1995; 221:67-73.