Background & objective: Currently, to preserve the anal function and improve the patients' quality of life, low anterior resection has become the preferred option in curative rectal cancer surgery. As the use of stapling instruments provides more reliable anastomoses in low anterior resection for rectal cancer, it enlarges the indication of this procedure. The aim of this study was to review the operation results and their outcomes of 449 rectal cancer patients who recieved of curative low anterior resections with stapling devices, and intent to find some measures that can reduce complications and improve long-term effects of this procedure.
Methods: The study included 449 patients who had a potentially curative anterior resection with stapled anastomosis in rectal cancer between Jan.1990 and Sept. 2002 at Sun Yat-sen University Cancer Center. All patients had complete follow-up data. All data were analyzed by SPSS8.0 software, risk factors for anastomotic leakage and recurrence were analyzed by Logistic regression, survival was analyzed by life table, and prognostic factors were screened by multivariate COX model.
Results: There were 11 cases of anastomotic leakage and 23 cases of anastomotic recurrence after operation. The 5-year survival rate was 78.4%. Age of >/= 65 years, and tumor involvement of more than half circumference were risk factors for anastomotic leakage, blood transfusion during operation was the risk factor for anastomotic recurrence. The independent factors for poor survival were stage of disease and tumor differentiation.
Conclusions: Stapling devices can improve the anal reservation rate in low rectal cancer surgery, and stapled anastomoses is safe and feasible. Adequate preparation of bowel ends, a tension-free anastomosis with excellent blood supply and skilled stapled anastomoses were key measures to reduce anastomotic leakage, While TME, multidisciplinary therapy and the principle of avoiding medical spread, were key measures to improve treatment effect of rectal cancer.