In a 31-year period of practice in Coloproctology, from 1965 to 1996, the author had the opportunity to attend 24,200 patients, bearing 923 (3.8%) cancer of the large bowel. Eight hundred and seventy (870 - 3.6%) of the tumours were colorectal cancer (adenocarcinoma) and 53 (0.2%) were carcinoma of the anus of several hystological types. In 490 cases (56.3%) cancer were localized in the colon and 380 (43.7%) in the rectum. The main purpose of this study was to collect data concerning 380 patients bearing rectal cancer attended from 1965 to 1996, 373 of them undergoing surgery, with enphasis to surgical techniques specially 47 surgical complications. Cancer were far more common in the upper (126; 33.1%) and low (172; 45.3%) than in the middle rectum (82; 21.6%). Resecability of tumours of the upper rectum reached 88.9% (112 patients), being abdominal rectosigmoidectomy with handmade anastomosis the most used surgery (76 patients; 60.3%). Resecability of tumours of the middle rectum reached 90.2% (112 patients), being abdominal rectosigmoidectomy with handmade and stappled anastomosis the most used surgery (40 patients; 48.7%). Resecability of tumours of the low rectum reached 89.5% (112 patients), being abdominaperineal amputation (Miles) the most used surgery (154 patients; 74.4%). Resecability of tumour was very high reaching 88.9% (338 patients). The most used surgical technique was Miles procedure (135 patients; 35.5%) and abdominal rectosigmoidectomy with handmade and stappled anastomosis (130 patients; 34.3%). Immediate major surgical complication rate was 12.6% (47 cases in 380 patients); and mortality rate was 1.6% (6 cases). The two most used surgical techniques presented low complication rate: Miles procedure - 135 surgeries, 13 complications (9.6%) and 2 deaths (1.5%); and abdominal rectosigmoidectomy with hand made and stappled anastomosis - 130 surgeries, 19 complications (14.6%) and 2 deaths (1.5%). The highest immediate major surgical complication rate was caused by endoanal rectosigmoidectomy and stappled colon to anus anastomosis (30.7%); and the lowest was due to Miles procedure (9.6%). The highest mortality rate was caused by endoanal rectosigmoidectomy and stappled colon to anus anastomosis (7.7%); and the lowest was due to Miles procedure (1.5%). The most common among the 47 complications were due to the anastomosis (15 cases of leakage and 6 cases of stenosis), following: abscesses (3 cases of abdominal, 4 cases of pelvic and 2 cases of perineal abscesses), necrosis of the rectal stump (4 cases), necrosis of colostomy (4 cases), small bowell obstruction (3 cases), hemorrhage (4 cases) and surgical lesion of the left urether (2 cases). Surgical procudure in each case of complication depended on conditions of the patient, of the disease, of the evolution and severity of the complication and of the technical resources of each time when the patients were attended.
Complications in surgery for rectal cancer; surgery in rectal cancer; rectal cancer; rectal surgery
