Changes in the treatment of rectal carcinoma and effects on local recurrence

M. W. Odou and T. X. O'Connell

We divided 563 patients with rectal adenocarcinoma located between 5 and 15 cm from the anal verge, who underwent curative resections, into two groups. The first had surgery from 1973 to 1978, before the introduction of the intraluminal stapling device (ISD), whereas the second group consisted of patients operated on between 1979 and 1983, when the stapler was commonly used. The number of low anterior resections (LARs) dramatically increased from 46% (113/248) during the first period to 62% (196/315) during the second. The major contribution to this increase occurred in tumors of the midrectum (5 to 10 cm), where a threefold rise in LARs was seen. Despite this increase in LARs, local recurrence overall was not significantly affected. Among patients undergoing LARs for mid-rectal lesions, local recurrence actually decreased from 34% (10/29) to 17% (16/95). This improvement may be secondary to greater distal margins of resection afforded by the ISD. The ISD has allowed more LARs, thus preserving normal bowel function and quality of life without compromising treatment goals.