Survival and recurrence after a sphincter-saving resection and abdominoperineal resection for adenocarcinoma of the rectum at or below the peritoneal reflection: a multivariate analysis.

PURPOSE: The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival and recurrence after curative surgery.

METHODS: This retrospective study included 184 patients who underwent curative surgery achieved by the following two types of operation between 1989 and 1998: (1) SSR ( n = 116 patients) including a low anterior resection with either double-stapling technique ( n = 86) or transanal coloanal anastomosis ( n = 30); (2) APR ( n = 91). The outcome factors evaluated were survival and tumor recurrence. Both univariate and corrected (multivariate Cox's and logistic regression) analyses were used to evaluate the data. The median follow-up was 47.4 months for patients alive at study conclusion.

RESULTS: Disease-free and disease-specific survivals, and the frequency and location of recurrence after surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-free survival or in the development of both local and distant recurrences after surgery. In addition, tumor-related factors (stage or histologic grade) were significant predictors of the outcome after surgery.

CONCLUSIONS: The type of operation (SSR or APR) did not affect the survival or recurrence after a curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection.