A retrospective analysis of ultralow anterior resection vs. abdomino-perineal resection for lower rectal cancer.

Background/aims: The aim of this study was to compare the oncological outcome of ultralow anterior resection (ULAR) and abdominoperineal resection (APR) for lower rectal cancer.
Methodology: Medical records of 276 patients with lower rectal cancer of whom 140 underwent ULAR and 136 underwent APR were included in a retrospective comparative study. Clinicopathological parameters, overall survival and tumor relapse and prognostic factors were analyzed retrospectively.
Results: There was no postoperative mortality in either group. Medical and surgical morbidity, especially pelvic abscess formation were similar in the two groups. The operation time was longer in the APR group (p<0.001). The hospital stay was shorter in the ULAR group (p=0.003). The 5 year overall and disease-free survival rates were 60.5% and 51.1%. There was no difference of overall and disease-free survival (p>0.05), between ULAR and APR surgery at 5 years. Patients who underwent ULAR showed more total recurrence (34.3% vs. 22.1%, p=0.031) and more local recurrence (20.7% vs. 8.8%, p=0.01) but showed no difference in distant recurrence (13.6% vs. 13.2%, p=0.92).
Conclusions: Ultralow anterior resection and abdominoperineal resection have similar long-term outcome in lower rectal cancer. In tumor local relapse, APR is more effective than ULAR, but in distant metastasis, it not better than ULAR.