Comparison And Analysis Of 5-year Survival Rate Between Stapling Device Application On Sphincter-saving Operation And Miles Operation In The Treatment Of Low Rectal Carcinoma

Objective:To compare the difference between local recurrence rate and 5-year survival rate of Miles surgery and anal sphincter preservation surgery using stapler on low rectum cancer. And to explore the indication of the using of stapler for low rectal cancer during sphincter preservation surgery, and the selection of surgical options for low rectal cancer.Methods:196 cases of low rectal cancer who admitted to China-Japan Union Hospital of Jilin University and accepted operative treatment between March 2000 and March 2002 were analyzed retrospectively. 53 rectal tumours were located in 3-5cm from anus, 61 were located in 5-6cm, 82 in 6-7cm. Miles surgery were performed on 107 patients, and stapling device application on Sphincter-saving surgery were performed on 89 patients. Two groups were conducted in accordance with the new TNM stage, and compare local recurrence rate and 5-year survival rate of the two .Results:(1)There is no significant difference on gender, age, liver metastasis, pathological type, the primary tumor size, depth of invasion, tumor location, histological degree of penetration, infiltrated circumference of intestine, and the regional lymph node metastasis between the two groups (p>0.05). (2) In accordance with the late TNM,there is no statistically difference between the 2- and 5-year survival rates of the two groups on I, II and III (p>0.05), while in TNM IV,the two ways of the surgery is analyzed by univariate analysis, we found the mean survival duration is longer in Mile's procedure(20.10±1.52 months versus 13.33±0.81 months), and there is remarkable difference in this issue of two groups handled by the Log-rank survival ratecurve (p<0.01).(3)Inthe patients whose tumors were in 5-7cm from anus, there is no significant difference between the 2- and 5-year survival rates of the two groups (p>0.05).Conclusion:(1)Stapling device application on sphincter-saving surgery should be performed to consult the individual condition, location of tumor, depth of infiltration, degree of differentiation, with lymph nodes metastasis or not and the instruments.(2)We find out that the sphincter preservation surgery with stapler can be performed to the low rectal cancer in the stage of TNM I, II and III, which is worthy to spread out. But if it's in TNM IV Patients who have a good performance status , minimal metastatic disease and normalpreoperative liver function tests and complete resection can be carried out , we should resect the primary carcinoma via Mile's surgery and aggressive systemic chemotherapy.(3)Stapling device application on sphincter-saving surgery in low rectal carcinoma,the resection length of carcinoma's margin matchs each of the following conditions can prognosticate good outcome:①TNM- stageⅠ(T1 N0 M0,T2 N0 M0) , Well-Differentiated and moderately differentiated adenocarcinoma,infiltrated circumference≤1/2,the length≥2.0cm,②ⅡA(T3 N0 M0),ⅡA(T3 N0 M0),ⅡB(T4 N0 M0),ⅢA(T1/T2N1M0),infiltrated circumference > 1/2 ; Well-Differentiated and moderately differentiated adenocarcinoma,the length≥2.5cm.③ⅢB(T3/ T4 N1 M0),ⅢC(TanyN2 M0) ,infiltrated circumference≤1/2; moderately differentiated and poorly differentiated adenocarcinoma,the length≥3.0cm, pathological examination after surgery,there is no cancer cell residues distal colorectal cancer. However, the choice of surgery indications is very important for carcinomas ofⅢB,ⅢC.Not only preserved anus but ignore the complete removal of carcinoma.