Does the distance from the anal verge of extraperitoneal rectal tumors affect the postoperative and oncologic outcomes?

Francisco Schlottmann, Manuel Maya, Alejandro Sanchez Ruiz, Sebastian Guckenheimer, Maximiliano Bun, Nicolas Rotholtz. Hospital Aleman of Buenos Aires

Introduction: There is weak evidence that in patients with rectal cancer the distance from the anal verge of the lesion affects the postoperative and oncologic outcomes. Those with low rectal cancer would present higher rate of complications and worse oncologic prognosis. The aim of this study is to evaluate whether the distance from the anal verge of extraperitoneal rectal tumors affects the outcomes.

Methods and procedures: In this retrospective study, patients with extraperitoneal rectal tumors undergoing laparoscopic surgery during the period 2003 – 2012 were included. The cohort was divided into two groups according to the height of the tumor; G1: Low rectal cancer (0-7 cm) and G2: Medium rectal cancer (7-12 cm). A subanalysis was performed over G1 according to the surgery in abdominoperineal resection (APR) or low anterior resection (LAR). Demographic variables, surgical results, recovery parameters and oncologic outcomes were analyzed. Statystical análisis thorugh the X2 test, T test and one factor anova was performed using SPSS v20.

Results: In the period 87 patients were operated of wich 56.3 % were men. The mean age was 64 (29 -87) years. Forty (46 %) belonged to G1 and 47 (54 %) to G2. Mean follow-up was 42.1 (6-102) months. The number of patients who received neoadjuvant therapy was higher in G1 (G1: 61 % vs G2: 32 %, p: 0.006). Surgeries performed were 10 (12 %) APR, 68 (78 %) LAR and 9 (10 %) LAR with intersphincteric dissection. A trend to higher conversion in G2 was recorded. There was no difference in recovery parameters between the two groups. While no differences were found in postoperative and oncologic results between both groups, patients in G1 undergoing APR had a major complications rate (p: 0.017) and a greater long term recurrence (p: 0.06)

Conclusion: The height of the tumor does not affect the outcomes except those subject to APR.

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