Resection and sutured peranal anastomosis for carcinoma of the rectum

Resection and peranal suture is now an accepted technique for low rectal carcinoma; however, long-term results of large numbers are not known. Eighty-four patients who had this procedure at a specialist institution between 1972 and 1985 are reviewed. There was a low operative mortality (2.4 percent), but a high complication rate with pelvic sepsis in 34 (40.5 percent) and anastomotic dehiscence (either partial or complete) in 40 (47.6 percent). The crude five-year survival rate was 56 percent. Isolated local recurrence occurred in seven patients (9.2 percent) and in a further seven patients it was associated with systemic recurrence. The functional results were satisfactory with 92 percent of assessed patients having three or less bowel actions per day. Subsequent incontinence occurred in 8 of the 60 patients assessed and 5 of these needed proximal diversion. For patients in whom the only alternative is abdominoperineal excision of the rectum, these results confirm that there is no disadvantage in terms of potential cure and that the functional results are acceptable.