Abdominoperineal Resection For Rectal Carcinoma Research Articles

Prognostic significance of surgical perforation of the rectum during abdominoperineal resection for rectal carcinoma

Two hundred fifty patients were followed up after resection for carcinoma of the rectum. Sixty-four (25.6 percent) had a surgical perforation in the resected rectum. Perforation did not affect the long-term outcome in patients with Dukes' A or D tumors, but in patients with Dukes' B and C cancers the surgical defect was associated with an increased incidence of recurrent tumor (57 versus 34 percent) and a decreased 5 year survival rate (31 versus 46 percent). The local recurrence rate was significantly higher in patients with Dukes' B rectal cancer who had an iatrogenic perforation (25.9 percent) than in those without a perforation (8.1 percent). This increased local recurrence rate was as high as the local recurrence rate in patients with Dukes' C cancers (23 percent) with or without a perforation. Patients with Dukes' B or C cancers who had incomplete resection had survival patterns similar to those in patients with Dukes' D cancers. Failure to remove all gross tumor and failure to avoid rectal perforation during abdominoperineal resection increases the risk of recurrence and decreases the chance of long-term survival.

CT appearance of the pelvis after abdomino-perineal resection for rectal carcinoma.

CT scans of the pelvis in 40 patients who had undergone abdomino-perineal resection for advanced rectal carcinoma 2 weeks to 24 years earlier were reviewed to determine whether there was any difference between simple postoperative change and local recurrence. Of 21 patients with no recurrence, the postoperative bed was clean in 10 and contained minimal streaky densities in 11. In contrast, a globular mass of soft-tissue density greater than or equal to1.5 cm in diameter was noted near the operative site in 19 patients with recurrence. Factors which may contribute to the disparity between these findings and those of previous investigators are discussed.

Rectal carcinoma invading the prostate gland.

It is generally acknowledged that the two layers of the prostatoperitoneal fascia of Denonvillier, which lie as a transverse aponeurosis interposed between the posterior surface of the prostate and seminal vesicles and the anterior surface of the rectum seem to act as a protective barrier to neoplastic infiltration. Young,1in a study of 111 cases of primary prostatic carcinoma, observed only one instance in which invasion occurred through this fascia into the rectal mucosa with ulceration. Ackerman and del Regato,2in discussing primary rectal carcinoma, state that true invasion of the prostate occurs only rarely because Denonvillier's fascia usually provides protective check to intraprostatic invasion. At the same time, it is not a rare clinical experience in urological practice to encounter a patient two or three years following performance of an abdominoperineal resection for rectal carcinoma because of dysuria, hematuria, or symptoms of bladder-neck obstruction. Such a patient