Clinicopathological Studies on Local Recurrence of Carcinoma of the Rectum Following Abdominoperineal Resection

Takeshi Sekine, Shigeru Iwazaki, Yoshiyuki Kawashima, Yasuo Suda

Division of Abdominal Surgery, Saitama Cancer Center

Seventeen patients with local recurrence who had received curative abdominoperineal resection for carcinoma of the rectum (lower rectum and upper rectum) were compared clinicopathologically with 62 patients with no recurrence after not less than two years. The rate of local recurrence was 16.7%, the average period until recurrence was 12.9 months, and the carcinoma recurred in 88.2% of the cases within two years. All the local recurrences were in the lower rectum (Rb), and they occurred at a significantly high rate in the following cases: Type 3 (infiltratingulcerating type) (70.6%; p<0.01); a₂-ai depth of invasion (70.6%; p<0.05), especially ai (23.5%; p<0.01), n₂ (+) lymph node metastasis (64.7%; p<0.01) (including 41.2% lymph node metastasis in the internal and external iliac arterial system (p<0.01); and carcinoma infiltration (ew) not more than 1 mm at the external surgical surface (52.9%; p<0.05). Three and 5-year survival rates were 58.3% and 11.5% following curative resection, respectively, which was significantly lower (p<0.05; p<0.01) than that for the patients with no recurrence, and follow-up results were poor. These findings indicate that exhaustive dissection of lymph nodes associated with the internal and external iliac arterial system and extended preparation and resection of tumors including the surrounding tissues are important for abdominoperineal resection of carcinoma of the rectum, especially the lower rectum.

Key words
carcinoma of the rectum, local recurrence of carcinoma of the rectum, abdominoperineal resection, lymph node metastasis of carcinoma of the rectum, survival rate of the curative resection for carcinoma of the rectum

Reprint requests
Takeshi Sekine Division of Abdominal Surgery, Saitama Cancer Center
818 Komuro Ina-machi, Kitaadachi-gun, Saitama, 362 JAPAN

Accepted
December 12, 1990

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