engleski

Perianal amputation of rectum – overview of 5 years experience in University Hospital Dubrava Zagreb in comparation with recent literature

INTRODUCTION The results of surgical treatment of carcinoma of the rectum have been improved in the last decades, because of the availability of stapling device, the increasing use of adjuvant or neoadjuvant treatment and development of endoluminal surgery. The classical standard surgical technique for rectal carcinoma, abdominoperianal excision (Miles operation) has been gradually replaced by sphincter-saving surgery, but a subset of patients with rectal cancer will still require abdominoperianal resection. PATIENTS AND METHODS A retrospective database of 212 patients who underwent surgery for rectal cancer at University Hospital Dubrava between the years 2000 and 2005 was reviewed. Patients with primary adenocarcinoma of the rectum who underwent abdominoperianal resection were identified. Eighty-two patients underwent abdominoperianal amputation (APA) whereas 130 underwent conservative surgery referred to as sphincter-saving resection (SSR). From their medical chart we collected information regarding age, sex, distance of cancer from anal verge, type of operation, Dukes classification of cancer, postoperative dehiscence, operative wound infection and postoperative mortality. We compared our results with regarding the criteria which influence on choice of APA technique and the complication after this procedure with recent literature. RESULTS We collect data from the 82 patients who underwent APA. There were no differences between the groups concerning sex and age distribution. The cancer were in 58 patients localized in the lower rectum (0-5 cm from anal verge), 15 in the mid rectum (6-8) and 9 in the upper rectum (9-15). According to Dukes classification 16 patients were Dukes A, 29 patient Dukes B, 34 patients Dukes C and 3 patients were Dukes D. Short-term complications occurred in nine patients, we have 7 wound dechiscence, 3 in area of perianal wound, one case of intraabdominal bleeding. From long term complications we have uncompleted data, only one complication reported, ileus caused by adhesions. We have three deaths in early postoperative period. The median of days in hospital were 14.47. CONCLUSION When we compare our results with recent literature we can see that despite a new trend in treatment of rectal carcinoma we still have a high percentage of APA especially in patient with carcinoma of mid and upper rectum. Miles operation should be reserved for tumors located within 5 cm from anal verge rarely for mid rectum with lymphatic spread. The result which we obtain in patient who underwent APA and postoperative complication did not differ significantly in respect to recent literature.

rectal cancer; perianal amputation of rectum

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