Die Bedeutung der intersphinkteren Rektumresektion mit koloanaler Anastomose beim tiefsitzenden Rektumkarzinom

: From October 1992 to December 1996, 204 patients with rectal cancer were treated with tumor resection. Of all carcinomas 94 were localised in the distal, 71 in the middle and 39 in the proximal third of the rectum. Curative resection could be achieved in 74% to 85% of the cases depending on tumor localisation. A local R0-resection (no residual tumor) was achieved in 92% to 100%, partly due to preoperative radiochemotherapy in cases of locally advanced cancer. The percentage of protective stoma application ranged from 25% of the total number of resections to 89% in those cases with intersphincteric rectal resection. The peri- and postoperative complications were thoroughly documented. The number of complications increased with the distal extent of rectal resection. The median follow up period was 24.5 months. Local tumor recurrence was observed in 6 cases (3.1%) independent of the tumor location. Distant metastasis was seen in 16% of all patients during the follow up period. 73% of all patients are still alive, 23% died of tumor related and 4% of non tumor related reasons. Complete postoperative stool continence was reported by 73% of all patients, 14% were incontinent for liquid stool and 13% were affected by total stool incontinence. Excluding those who underwent rectum extirpation, 39% of the patients had a stoma. The extent of stool continence was closely related to the operative procedure. With intersphincteric resection, complete stool continence could only be achieved in 40% of the patients whereas 18% were incontinent for liquid stool, 14% were completely incontinent and 29% had a stoma at the time of observation. The rate of local recurrence was not increased after intersphincteric resection.