Abstract
From March 1990 to December 1992, 47 patients with primary or recurrent low rectal cancer under-went total rectal resection and a coloendoanal anastomosis. Rectal resection was extended downward to the ano-rectal junction. The restorative technique included a colo-endoanal anastomosis between the dentate line and a J-shaped colic reservoir. All lesions were located within 7 cm of the anal verge (within 6 cm in 33 primary cases). Macroscopic and histological radicality was documented in all cases. Pelvic recurrence occurred in six patients and was para-anastomotic in one case. Post-operative morbidity was low. Perfect continence was documented in 36 patients and 72 of the cases had one or two bowel movements a day. All but four patients are alive at a follow-up ranging from 6 to 40 months (median 20 months). This approach is a safe option to conventional total rectal excision with permanent colostomy for lower third rectal carcinoma.
Résumé
De mars 1960 à décembre 1992, 47 patients porteurs d'un cancer primitif ou d'une récidive d'un cancer du bas rectum ont subi une excision totale du rectum avec une anastomose colo-anale. La résection a été étendue distalement jusqu'à la jonction ano-rectale. Le rétablissement de la continuité a comporté une anastomose coloanale entre un réservoir colique en J et la ligne pectinée. Toutes les lésions siégeaient à moins de 7 cm de la marge anale (moins de 6 cm dans les 33 premiers cas). La radicalité de la résection a été documentée dans tous les cas par l'examen macroscopique et histologique. Six patients ont développé une récidive pelvienne et 1 une récidive para-anastomotique. Une continence parfaite a été observée chez 36 malades et la plupart des patients (72%) présentent 1 ou 2 exonérations par jour. A l'exception d'un patient, tous sont vivants. La survie varie de 6 à 40 mois avec une médiane de 20 mois. Ce nouvel abord représente une alternative satisfaisante et sûre à la traditionnelle amputation du rectum dans le traitement des cancers du rectum les plus bas situés.
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Leo, E., Belli, F., Baldini, M.T. et al. Total rectal resection and colo-anal anastomosis with colonic reservoir for low rectal cancer. Int J Colorect Dis 9, 82–86 (1994). https://doi.org/10.1007/BF00699418
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DOI: https://doi.org/10.1007/BF00699418