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Background: The problems associated with rectal surgery are frequently discussed with no reference being made to the distance of the tumor from the anal verge. This study examined the effect of the location of the tumor on early postoperative results., Patients and Methods: This was a multicenter study involving 75 German hospitals and 3756 patients, of whom 1463 had rectal carcinoma. On the basis of the location of the tumor (distance from the anal verge), four groups were distinguished: <4, 4-7.9, 8-11.9, and 12-16 cm., Results: Resection and abdominoperineal resection rates and the incidence of postoperative complications depended on the location of the tumor. Significantly higher resection rates and fewer specific complications, and a significant reduction in overall postoperative morbidity were found with tumor locations more than 8 cm from the anal verge. The highest anastomotic leak rate was observed with anastomoses less than 7 cm from the anal verge. The logistic regression showed that the distance of the tumor from the anal verge is an independent variable for the development of an anastomotic leak., Conclusions: Early results are greatly affected by the location of the rectal carcinoma. This applies to both abdominoperineal resection rates and specific postoperative complications, such as anastomotic leak rate and operation morbidity in general.

Since laparoscopic surgery has been applied to cancer, an increased number of secondary tumors implanted in the abdominal wall have been reported. Quality of surgery is paramount in the incidence of port-site recurrences. In large prospective series of laparoscopic colorectal surgery, their incidence (around 0.85%) was similar to that reported in open surgery (0.6 to 1.6%) while it is higher for unapparent gallbladder cancer (around 15%) due to direct wound contamination. Viable tumor cells are seeded by inadequate surgical technique or released by advanced tumors. Tumor cells are carried across the abdominal cavity by peritoneal fluid currents and surgical instruments, not by CO2 pneumoperitoneum. CO2 modifies the morphology of mesothelial cells and inhibits peritoneal macrophages. Differences in retroperitoneal/subserosal/intraluminal tumor xenograft models show that CO2 laparoscopy reduces tumor growth when compared to gasless laparoscopy and laparotomy. The local effects of pneumoperitoneum in the wound might be counteracted by using inert gases such as helium, drug-loaded CO2 or various antiadhesive or cytotoxic agents. In clinical practice, port-site recurrences can be effectively prevented by careful surgical technique and prophylactic wound irrigation.