Ultra-low Anterior Resection With Coloanal Anastomosis For Rectal Cancer Between 3-5cm From Anal Verge: The Clinical Results And The Evaluation Of Quality Of Life

PURPOSE: This study was undertaken to test the efficacy andfeasibility of Ultra-low anterior resection (ULAR) with total mesorectum excision (TME) and coloanal anastomosis (CAA) for rectal cancer between 3-5cm from anal verge by comparing the clinical results and the quality of life (QOL) with that of abdominoperineal resection (APR).METHODS: A total of 68 consecutive operations for rectal cancersbelow 5cm from anal verge between April 2001 and April 2002 has been documented and followed for 2 years. A total of 44 of the operations were ULAR, and 24 were APR.RESULTS: The respective mean operative time of ULAR group andAPR group was 128.2±37.2 minutes and 169.4±40.9 minutes (p<0.05), while the mean operative blood loss was 80.0±10.0ml and 120.0±12.0 ml (p<0.05). Both of the two groups had no complications duringoperations, and the incidence of postoperative complications of them had no statistical differences. In ULAR group, the incidence of postoperative complications was 9.1%, with 1 anastomosis leakage, 1 ileus and 2 incision infections, compared with the APR group which was 16.7% with 1 bleeding before sacrum,1 urinary fistula and 2 perineal infections. After operations, the hospitalization time in ULAR was shorter than that in APR. The local recurrence at 1 year was 9.1%(n=4) in ULAR and 8.3%(n=2) in APR (p>0.05). The total local recurrence at 2 year was 11.4%(n=5) after ULAR and 16.7%(n=4) after APR (p>0.05). In ULAR group, all of the 5 local recurrence were in Dukes C, with 4 adenocarcinoma in low differentiation and 1 patient whose tumor cells had been found to invade the whole rectal ring in operation, and among them there were 3 pelvis, 1 incision and 1 perineal recurrence .In APR group, 3 recurred in pelvis and 1 in perineum, 2 of which were adenocarcinoma in low differentiation in Dukes C and had been found to invade the whole rectal ring in operation. The mortality was 11.4%(n=5) after ULAR and 20.9%(n=5) after APR (n>0.05). There were no statistical differences in bowel frequency, diarrhea, constipation and bladder function between the two groups, but the ULAR group appeared greatly superior to the APR group in fecal continence and sexual function.CONCLUSION: ULAR for rectal cancer between 3-5cm from anal verge is feasible and safe in technique, and oncology principle is not compromised, provided with low local recurrence and mortality. ULAR can achieve better postoperative functions than APR, especiallyin fecal continence and sexual function.