Sphincter Preserving Operation for Carcinoma in the Rectum.

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Now, sphincter preserving operation for carcinoma in the rectosigmoid and upper rectum has widely justified in the view of radicality and post operative quality of life. However, to preserve sphincter for carcinoma in the lower rectum is still cotroversy.<BR>Since 1980, we have introduced peranal coloanal anastomosis (PAA) after resection of the rectum for extremely low rectal carinoma. As for postoperative complications, in 12.5 % of cases of PAA developed anastomotic dehiscence but no stenosis nor bleeding was occurred. All cases recovered to almost normal anal functions within 12 months after operation.<BR>Five year survival and local recurrence rate were compared retrospectively between 35 cases of PAA and 67 cases of abdominoperineal resetion (APR) undergone between 1980 to 1991 matching with clinical and pathological findings. In the location of tumor from anal verge, APR group situated significantly lower than PAA group (p<0.001).<BR>In 5-year survival, there. was no significant difference between PAA and APR group, 64.5%, 60.2% respectively. There was no significant differrence in two groups for local recurrence rate, 11.5 %, 13.4 % respectively.<BR>Even in carcinoma in the rectum as long as. an adequate distal margin of resection can be provides, PAA as SPO lower is justified in termes of radicality and postoperative quality of life comparing with APR
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