Comparative Outcomes of Low/Ultra-Low Anterior Rectal Resection and Valgus Resection in Elder Patients with Rectal or Anal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUAN Xiuwen ^1,2 , GAN Zhiming ^1,2 , WANG Xiaodong ^1,2 ,  LI Li ^1,2

1.Surgery Center of Gastro-enterology， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;;
2.West China Medical School /MCQ Group of West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

LI Li, Email: drlili116@126.com

Keywords：

Rectal cancer; Sphincter preserving surgery; Low anterior resection; Valgus resection

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Objective 　To compare the outcomes of low/ultra-low anterior rectal resection and valgus resection in elder patients with rectal or anal cancer.
Methods 　The clinical data of 184 patients with rectal or anal cancer， who were treated with extreme sphincter preserving surgery in West China Hospital from January 2009 to December 2011， were collected and analyzed retrospectively. The intraoperative and postoperative indexes between low/ultra-low anterior rectal resection group and valgus resection group were compared.
Results 　①There were no significant differences in the age，body mass index， gender， diameter of tumor， TNM stage， degree of differentiation， histological type， gross type， and complications before operation， such as hypertension， chronic obstructive pulmonary disease， cardiovascular diseases， diabetes， renal disease， and hypoproteinemia in two groups （P＞0.05）. ②Compared with the low/ultra-low anterior rectal resection group， the distance from the anal verge to the tumor was shorter （P＜0.05） and the distance of distal resec-tion margin of tumor was longer （P＜0.05） in the valgus resection group. ③There were no significant differences in the operation time， blood loss， ASA grade， and the postoperative complications in two groups （P＞0.05）. ④There were no significant differences in the duration of pulling out nasogastric tube， urinary catheter， and drainage tube， the duration of first passing flatus， first defecation， first oral intake， and first ambulation， and hospitalization cost （P＞0.05）. But the postoperative hospital stay and total hospital stay in the valgus resection group were significantly longer than those in the low/ultra-low anterior rectal resection group （P＜0.05）. ⑤All the patients were followed-up for 6-24 months （average 13 months）. During the following-up， only 1 case suffered local tumor recurrence in the valgus resection group. One case suffered distant metastases in the ultra-low anterior rectal resection and valgus resection group， respectively. Eight cases （4.35%） died， of which 4 cases （4.04%） in the low/ultra-low anterior rectal group and 4 cases （4.71%） in the valgus resection group. All the patients were in functional recovery of anal control after operation.
Conclusions 　As the extreme sphincter preserving surgery for elder patients with rectal or anal cancer， the low or ultra-low anterior rectal resection and valgus resection could both be used for elder patients with extreme-low rectal or anal cancer. However， valgus resection results in longer distal surgical margin than that low/ultra-low anterior rectal resection， and it is suitable for the patients with shorter distances from the anal verge to the tumor.

Citation： GUAN Xiuwen,GAN Zhiming,WANG Xiaodong,LI Li. Comparative Outcomes of Low/Ultra-Low Anterior Rectal Resection and Valgus Resection in Elder Patients with Rectal or Anal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(11): 1250-1256. doi: Copy

1.	赵任，李菁. 低位直肠癌保肛手术的若干问题[J]. 外科理论与实践， 2010， 15(4)：331-334.
2.	Heald RJ， Ryall RD. Recurrence and survival after total mesorectalexcision for rectal cancer[J]. Lancet， 1986， 1(8496)：1479-1482.
3.	Knight CD， Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler[J]. Surgery， 1980， 88(5)：710-714.
4.	吕东昊，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状[J]. 中国普外基础与临床杂志， 2007， 14(6)：713-715.
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7.	Tran Ba Loc P， du Montcel ST， Duron JJ， et al. Elderly POSSUM，a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients[J]. Br J Surg， 2010， 97(3)：396-403.
8.	唐绍贤，周志伟，王国强，等. 老年结直肠癌与非老年结直肠癌704例临床分析[J]. 广西医学， 2005， 27(4)：484-487.
9.	Marusch F， Koch A， Schmidt U， et al. The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management[J]. World J Surg， 2005， 29(8)：1013-1021.
10.	Paty PB， Enker WE， Cohen AM， et al. Treatment of rectal cancerwith low anterior resection coloanal anastomosis[J]. Ann Surg， 1994， 219(4)：365-373.
11.	Fischer A， Tarantino I， Warschkow R， et al. Is sphincter preserv-ation reasonable in all patients with rectal cancer?[J]. Int J Colo-rectal Dis， 2010， 25(4)：425-432.
12.	Neuman HB， Patil S， Fuzesi S， et al. Impact of a temporary stoma on the quality of life of rectal cancer patients undergoing treatment[J]. Ann Surg Oncol， 2011， 18(5)：1397-1403.
13.	Yu DS， Huang XE， Zhou JN. Comparative study on the value of anal preserving surgery for aged people with low rectal carcinoma in Jiangsu， China[J]. Asian Pac J Cancer Prev， 2012， 13(5)：2339-2340.
14.	鲁兵，傅传刚，刘连杰，等. 75岁以上高龄患者低位直肠癌保肛手术后控便情况分析[J]. 中华胃肠外科杂志， 2005， 8(6)：496-499.
15.	Tytherleigh MG， McC Mortensen NJ. Options for sphincter preservation in surgery for low rectal cancer[J]. Br J Surg， 2003， 90(8)：922-933.
16.	Tsubaki M， Ito Y， Fujita M， et al. Use of the modified double-stapling technique with vertical division of the rectum during a sphincter-preserving operation for the treatment of a rectal tumor[J]. Asian J Surg， 2012， 35(3)：110-112.
17.	Parks AG. Per-anal anastomosis[J]. World J Surg， 1982， 6(5)：531-538.
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23.	Fu CG， Gao XH， Wang H， et al. Treatment for early ultralow rectal cancer：pull-through intersphincteric stapled transection and anastomosis (PISTA) versus low anterior resection[J]. Tech Coloproctol， 2013， 17(3)：283-291.
24.	Moore JW， Chapuis PH， Bokey EL. Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum[J]. Aust N Z J Surg， 1996， 66(12)：820-823.
25.	Sato H， Maeda K， Hanai T， et al. Modified double-stapling technique in low anterior resection for lower rectal carcinoma[J]. Surg Today， 2006， 36(1)：30-36.
26.	Saito N， Ito M， Kobayashi A， et al. Sphincter-saving resection for low rectal cancer[J]. Nihon Geka Gakkai zasshi， 2011， 112(5)：318-324.
27.	Manca F， Durante V， Infelise P， et al. Defecography and mano-metry in the postoperative follow-up of patients treated with colo-anal anastomosis by the Parks technique for neoplasm stenosis of the rectum[J]. Minerva Med， 1992， 83(12)：791-794.
28.	Han JG， Wei GH， Gao ZG， et al. Intersphincteric resection with direct coloanal anastomosis for ultralow rectal cancer：the experience of People’s Republic of China[J]. Dis Colon Rectum， 2009，.
29.	Manceau G， Karoui M， Werner A， et al. Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients：a systematic review[J]. Lancet Oncol， 2012， 13(12)：525-536.
30.	王刚成，韩广森，任莹坤. 高龄高危低位直肠癌患者的术式探讨[J]. 中国肿瘤临床与康复， 2013， 1(1)：49-52.
31.	Orsini RG， Thong MS， van de Poll-Franse LV， et al. Quality of life of older rectal cancer patients is not impaired by a permanent stoma[J]. Eur J Surg Oncol， 2013， 39(2)：164-170. doi：10.1016/j.ejso.2012.10.005.
32.	(5)：950-957.

1. 赵任，李菁. 低位直肠癌保肛手术的若干问题[J]. 外科理论与实践， 2010， 15(4)：331-334.
2. Heald RJ， Ryall RD. Recurrence and survival after total mesorectalexcision for rectal cancer[J]. Lancet， 1986， 1(8496)：1479-1482.
3. Knight CD， Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler[J]. Surgery， 1980， 88(5)：710-714.
4. 吕东昊，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状[J]. 中国普外基础与临床杂志， 2007， 14(6)：713-715.
5. 李立. 结直肠癌外科应用技术的规范与创新(四)[J]. 中国普外基础与临床杂志， 2006， 13(4)：461-468.
6. 李立. 结直肠癌外科应用技术的规范与创新(五)[J]. 中国普外基础与临床杂志， 2006， 13(5)：597-607.
7. Tran Ba Loc P， du Montcel ST， Duron JJ， et al. Elderly POSSUM，a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients[J]. Br J Surg， 2010， 97(3)：396-403.
8. 唐绍贤，周志伟，王国强，等. 老年结直肠癌与非老年结直肠癌704例临床分析[J]. 广西医学， 2005， 27(4)：484-487.
9. Marusch F， Koch A， Schmidt U， et al. The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management[J]. World J Surg， 2005， 29(8)：1013-1021.
10. Paty PB， Enker WE， Cohen AM， et al. Treatment of rectal cancerwith low anterior resection coloanal anastomosis[J]. Ann Surg， 1994， 219(4)：365-373.
11. Fischer A， Tarantino I， Warschkow R， et al. Is sphincter preserv-ation reasonable in all patients with rectal cancer?[J]. Int J Colo-rectal Dis， 2010， 25(4)：425-432.
12. Neuman HB， Patil S， Fuzesi S， et al. Impact of a temporary stoma on the quality of life of rectal cancer patients undergoing treatment[J]. Ann Surg Oncol， 2011， 18(5)：1397-1403.
13. Yu DS， Huang XE， Zhou JN. Comparative study on the value of anal preserving surgery for aged people with low rectal carcinoma in Jiangsu， China[J]. Asian Pac J Cancer Prev， 2012， 13(5)：2339-2340.
14. 鲁兵，傅传刚，刘连杰，等. 75岁以上高龄患者低位直肠癌保肛手术后控便情况分析[J]. 中华胃肠外科杂志， 2005， 8(6)：496-499.
15. Tytherleigh MG， McC Mortensen NJ. Options for sphincter preservation in surgery for low rectal cancer[J]. Br J Surg， 2003， 90(8)：922-933.
16. Tsubaki M， Ito Y， Fujita M， et al. Use of the modified double-stapling technique with vertical division of the rectum during a sphincter-preserving operation for the treatment of a rectal tumor[J]. Asian J Surg， 2012， 35(3)：110-112.
17. Parks AG. Per-anal anastomosis[J]. World J Surg， 1982， 6(5)：531-538.
18. 邱辉忠，林国乐，吴斌，等. 结肠肛管吻合术在低位直肠癌保肛术中的应用(附35例分析)[J]. 中国实用外科杂志， 2005， 25(3)：145-147.
19. Akagi Y， Kinugasa T， Shirouzu K. Intersphincteric resection for very low rectal cancer：a systematic review[J]. Surg Today， 2013， 43(8)：838-847.
20. Kumar A， Daga R， Vijayaragavan P， et al. Anterior resection for rectal carcinoma-risk factors for anastomotic leaks and strictures[J]. World J Gastroenterol， 2011， 17(11)：1475-1479. Doi：10. 3748/wjg.v17. i11. 1475.
21. 戴勇，姜金波，张晓明，等. 外翻脱出式内括约肌切除的直肠癌根治术[J]. 中华外科杂志， 2006， 44(9)：628-630.
22. 戴勇，姜金波，张晓明，等. 单吻合器联合外翻脱出技术在直肠癌超低位前切除中的应用[J]. 中华医学杂志， 2006， 86(12)：822-825.
23. Fu CG， Gao XH， Wang H， et al. Treatment for early ultralow rectal cancer：pull-through intersphincteric stapled transection and anastomosis (PISTA) versus low anterior resection[J]. Tech Coloproctol， 2013， 17(3)：283-291.
24. Moore JW， Chapuis PH， Bokey EL. Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum[J]. Aust N Z J Surg， 1996， 66(12)：820-823.
25. Sato H， Maeda K， Hanai T， et al. Modified double-stapling technique in low anterior resection for lower rectal carcinoma[J]. Surg Today， 2006， 36(1)：30-36.
26. Saito N， Ito M， Kobayashi A， et al. Sphincter-saving resection for low rectal cancer[J]. Nihon Geka Gakkai zasshi， 2011， 112(5)：318-324.
27. Manca F， Durante V， Infelise P， et al. Defecography and mano-metry in the postoperative follow-up of patients treated with colo-anal anastomosis by the Parks technique for neoplasm stenosis of the rectum[J]. Minerva Med， 1992， 83(12)：791-794.
28. Han JG， Wei GH， Gao ZG， et al. Intersphincteric resection with direct coloanal anastomosis for ultralow rectal cancer：the experience of People’s Republic of China[J]. Dis Colon Rectum， 2009，.
29. Manceau G， Karoui M， Werner A， et al. Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients：a systematic review[J]. Lancet Oncol， 2012， 13(12)：525-536.
30. 王刚成，韩广森，任莹坤. 高龄高危低位直肠癌患者的术式探讨[J]. 中国肿瘤临床与康复， 2013， 1(1)：49-52.
31. Orsini RG， Thong MS， van de Poll-Franse LV， et al. Quality of life of older rectal cancer patients is not impaired by a permanent stoma[J]. Eur J Surg Oncol， 2013， 39(2)：164-170. doi：10.1016/j.ejso.2012.10.005.
32. (5)：950-957.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Outcomes of Low/Ultra-Low Anterior Rectal Resection and Valgus Resection in Elder Patients with Rectal or Anal Cancer

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