Safety and Efficacy of Low Anterior Resection for Rectal Cancer

作者：Warren E. Enker, Nipun B. Merchant, Alfred M. Cohen, Nicole M. Lanouette, Carol Jane Swallow, José G. Guillem, Philip B. Paty, Bruce Daniel Minsky, Katherine Weyrauch, Stuart H. Q. Quan · 发表于：Annals of Surgery · 年份：1999 · DOI：10.1097/00000658-199910000-00010 · 被引用次数：301 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal and Anal Carcinomas、Genetic factors in colorectal cancer

OBJECTIVE: To determine perioperative morbidity, survival, and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service. The primary objective was to assess the surgical complications associated with preoperative radiation sequencing. SUMMARY BACKGROUND DATA: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, sexual, and bladder function. Surgical resection using sharp perimesorectal dissection is important for achieving these goals. The complications and mortality rate of this surgical strategy, particularly in the setting of preoperative chemoradiation, have not been well defined. METHODS: There were 1233 patients with primary rectal cancer treated at the authors' cancer center from 1987 to 1995. Of these, 681 underwent low anterior resection and/or coloanal anastomosis for primary rectal cancer. The surgical technique used the principles of sharp perimesorectal excision. Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation (Preop RT, n = 150) and those not receiving preoperative chemoradiation (No Preop RT, n = 531). Recurrence and survival data were determined in patients undergoing curative resection (n = 583, 86%) among three groups of patients: those receiving Preop RT (n = 131), those receiving postoperative chemoradiation (Postop RT, n = 110), and those receiving no radiatio...