Locoregional reccurence, distant metastasis and survey of the rectum cancer patients that curative operation performed as low anterıor resection or abdominoperineal resection

OBJECTIVEThe aim of this study is to compare the rectum cancer patients treated with low anterior resection versus abdominoperineal resection for tumoral and patient speciality and positive radial margin, locoregional reccurence and overall survival.MATERIAL AND METHODSBetween June 1999-January 2011, prospective produced data of 228 patients' files, pathology reports and patients' demographic data were analyzed retrospectively who were operated in Dokuz Eylul University Department of Surgery Colorectal Unit. The clinical examination of distance to anal verge and location of the tumor in all patients made by the general surgeon with digital rectal examination or rigid sigmidoscopy. All local staging in patients with high-resolution MRG or endorectal-coil MRI was performed. İn this study, the patients had curative resection (R0) were included. Lost in the process of neoadjuvant therapy in patients and stage IV patients were not included in the analysis. With the multidisciplinary approach treatment plan for patients organized with colorectal surgery, radiology, medical oncology, radiation oncology, gastroenterology and pathology departments. Neoadjuvant therapy had given to the patients with advanced stages of colorectal cancer. 6-8 weeks after neoadjuvant therapy surgery (otonom nerve preserving total mezorectal excion) performed for curatif resection. The specimens taken to the standart pathalogical evaluation as described by Quirke and friends about radial margin distance 1mm. On pathalogical reports, TME quality rating started after 2005. Stage II and III of rectal cancer under the age of 75, post-operative chemotherapy was administered to patients without severe cardiac disease. Patients undergoing low anterior resection and abdominoperineal resection of local recurrence and survival rates were calculated. Statistical analysis included X ² test, t test, Kaplan Meier analysis, were used. Statistical significance level p <0.05 was adopted.RESULTSOf 228 rectal cancer patient with curative resection, LAR (n = 171, 75%), or APR (n = 57, 25%) performed. Two group was similar on sex, average age, in terms of tumor size. Low rectum (0-5 cm) located at 68 (29%) patients, 18 (26%) LAR and 50(74%) underwent cine APR (p = 0.000).The clinical staging of the LAR patients, 15 (8. 7%) patients with stage I / II but in APR group none of the patients who were not early-stage (p=0.013). LAR 138 patients with clinical stage III, while the APR 56 (100%) patients with clinical stage III respectively (p = 0.013).İn LAR group total of 164 patients with radial margin were evaluated in terms of radiological involvement, 33 (19%) patients were positive when the APR group, 11 (22%) patients were positive (p = 0,409). Limit of resection of the pathological examination of environmental data report assessed 225 patients. LAR in those 20 (11%) patients in APR-positive, while 9 (16%) patients were positive (p = 0,412). On the data, total mesorectal excision (TME) quality,157 patients had information. LAR of them in those 103 cases (83%) were fully or almost completely, while the on the APR group, this number is 30 (69%), respectively (p = 0.01). The mean follow-up was 41.5 ± 25.9 months (6-143) is. In terms of local recurrence and distant metastasis after surgery in the survival of at least 6 months 217 (74%) patient were evaluated. Five patients died due to peroperative mortality (2%), follow-up reached 4 (2%) patients died during chemotherapy and 2 (0.8%) patients were excluded from the analysis of local recurrence and survival statistics. Low anterior resection group had 169 patients and 16 (9%) patients showed local recurrence. Abdominoperineal resection group had 48 patients and 5 (10%) patients showed local recurrence (P = 0,946). Distant metastases rates of group LAR patients 28 (16%) patients and for the group APR rates were 13 (24%) (P = 0.193). The overall results of the survival for 217 patients, 44 (20%) patients died due to disease. The average life expectancy of all patients was 35.10 (6-143) months. For LAR group 35.25 and for the APR group 34.70 months (log rank P = 0,821). One-year survival of 98% of 217 patients in our study, 3-year survival of 80% and 5-year survival 64%. In our series, the two groups 1, 3 and 5-year survival rates were compared: the LAR group, a 1-year survival rate of 97%, 3-year survival rate of 78%, 5-year survival rate 69%. Abdominoperineal resection group, a 1-year survival rate of 98%, 3-year survival rate of 85%, 5-year survival rate is the rate of 67%, respectively (P = 0,821).CONCLUSIONAccording to the results of our series for APR patients, the quality of TME worse than LAR patients and they had higher rate of perforation of specimens, although no significant difference between the two groups formed in terms of radial margin involvement, than no significant difference for local recurrence and survival was observed. However, increasing the number of patients with prolonged follow-up period, and these findings are will be change.Key words: Lower rectal cancer, local recurrence, survival