Palliation for rectal cancer. Resection? Anastomosis?
M. R. Moran, D. A. Rothenberger, C. J. Lahr, J. G. Buls and S. M. Goldberg
There is no agreement regarding the proper management of patients with
advanced carcinoma of the rectum. We performed a study to clarify whether
palliative resection with or without primary anastomosis is worthwhile and
safe. Among 679 patients managed for cancer of the rectum, 125 were
considered incurable and underwent palliative procedures. High and low
anterior resections were performed in nine and 57 cases, respectively,
abdominoperineal resection in 26, Hartmann's procedure in three, simple
diverting colostomy in 17, and transanal excision in 13. The overall
postoperative mortality rate was 0.8%. Postoperative morbidity was 18% in
abdominal operations and none in local excisions. Among patients treated by
abdominal resections, only one required subsequent reoperation for colonic
obstruction secondary to local recurrence. The median survival was 6.4
months for patients treated by diverting colostomy, 14.8 months for
abdominally resected cases, and 14.7 months for transanal excisions. We
conclude that palliative resection, often with primary anastomosis or local
transanal excision, can be done safely in patients with incurable rectal
cancer. We believe this approach improves the quality of the remaining life
for these patients.
