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Resection? Anastomosis?

Manuel R. Moran, MD; David A. Rothenberger, MD; Christopher J. Lahr, MD; John G. Buls, MD; Stanley M. Goldberg, MD

Arch Surg. 1987;122(6):640-643.

Abstract
• 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.

(Arch Surg 1987;122:640-643)

Author Affiliations
From the Department of General Surgery, University Clinical Hospital, School of Medicine of Salamanca, Spain (Dr Moran); the Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis (Drs Rothenberger, Buls, and Goldberg); and the Department of Surgery, USAF Scott Medical Center, Scott Air Force Base, Ill (Dr Lahr).

Footnotes
Accepted for publication Jan 9, 1987.

Read before the 94th Annual Meeting of the Western Surgical Association, Dearborn, Mich, Nov 17, 1986.

Reprint requests to 280 N Smith Ave, No. 350, St Paul, MN 55102 (Dr Rothenberger).

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ABSTRACT