Staplers in oncologic surgery increase the incidence of low anterior resections of the rectum: 11-year analysis (1996−2006)
Abstract
Background Low rectal cancers pose a difficulty in performing a low/ultralow colorectal anastomosis. Stapler techniques of anastomosis are more frequently used due to speed and technically simpler performance of low anastomosis. The goal of the study was to conclude whether the use of staplers has increased the share of continuous rectal resections because of cancer at UHC Zagreb. Methods In the 11-year period (1996−2006) all patients with rectal cancer at the Division of Abdominal Surgery were included in the study. Staplers in rectal surgery were used during the entire study period, but continuously and constantly after year 2000. Results The study involved 413 operated patients which included 149 low anterior resections, 156 Miles' operations and the remaining ones were Hartmann's and palliative operations. Over the years the number of all operations constantly increased with an increasing incidence of low rectal resections. The incidence of Miles' operation remained unchanged with value of around 40%. Conclusions Continuity restoration after rectal resection increases the quality of life with equal oncologic safety in comparison with abdominoperineal resection. With the constant use of staplers in oncologic rectal surgery there is an increasing incidence of low rectal resections. Unfortunately, the incidence of Miles' operations remains constant.
Downloads
References
Hodgson DC, Fuchs CS, Ayanian JZ. Impact of patient and provider characteristics on the treatment and outcomes of colorectal cancer. J Natl Cancer Inst 2001;93: 501−515.
Hodgson DC, Zhang W, Zaslavsky AM, Fuchs CS, Wright WE, Ayanian JZ. Relation of hospital volume to colostomy rates and survival for patients with rectal cancer. J Natl Cancer Inst 2003;95: 708−716.
Marusch F, Koch A, Schmidt U, Pross M, Gastinger I, Lippert H. Hospital caseload and the results achieved in patients with rectal cancer. Br J Surg 2001;88: 1397−1402.
Simons AJ, Ker R, Groshen S, et al. Variations in treatment of rectal cancer: The influence of hospital type and caseload. Dis Colon Rectum 1997;40: 641−646.
Black RJ, Bray F, Ferlay J, Parkin DM. Cancer incidence and mortality in the European Union: Cancer Registry Data and Estimates of National Incidence for 1990. Eur J Cancer 1997;33: 1075–1107.
Troisi RJ, Freedman AN, Devesa SS. Incidence of colorectal carcinoma in the US. An update of trends by gender race, age subsite, and stage, 1975–1994. Cancer 1999;85: 1670–1676.
Ponz de Leon M, Antonioli A, Ascari A, Zanghieri G, Sacchetti C. Incidence and familial occurrence of colorectal cancer and polyps in a health-care district of Northern Italy. Cancer 1987;60: 2848–2859.
Ponz de Leon M, Marino M, Benatti P, et al. Trend of incidence, subsite distribution and staging of colorectal neoplasms in the 15-year experience of a specialised cancer registry. Ann Oncol 2004;15:940−946.
Ponz de Leon M, Rossi G, di Gregorio C, et al. Epidemiology of colorectal cancer: the 21-year experience of a specialised registry. Intern Emerg Med 2007 Nov 29: 269−279 [Epub ahead of print].
Schrag D, Panageas KS, Riedel E, et al. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 2002;236: 583−592.
O'Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994;331: 502−507.
Meyerhardt JA, Tepper JE, Niedzwiecki D, et al. Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: findings from the Intergroup 0114 Study. J Clin Oncol 2004;22: 166−174.
Copyright (c) 2013 Acta Chirurgica Croatica

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby authorize the Acta Chirurgica Croatica (ACC) to publish their work.
The authors are aware that although ACC is Open Access journal, the copyright of all material published is vested in ACC. Open access articles are freely available to read, download, and share from the time of publication under the terms of the Creative Commons License Attribution ‐ NonCommerical No Derivative (CC BY‐NC‐ND) license. This license does not permit reuse for any commercial purposes nor does it cover the reuse or modification of individual elements of the work (such as figures, tables, etc.) in the creation of derivative works without specific permission of ACC and appropriate acknowledgment of its source. The authors permit ACC to allow third parties to copy any part of the work without asking for permission, provided that the reference to the source is given and that this is not done for commercial purposes. Except for copyright, other proprietary rights related to the work (e.g., patent or other rights to any process or procedure) shall be retained by the author. To reproduce any text, figures, tables, or illustrations from this work in future works of their own, the author must obtain written permission from ACC.
Each of the author(s) hereby also grants permission to ACC to use such author’s name and likeness in connection with any past, present or future promotional activity by ACC, including, but not limited to, promotions for upcoming issues or publications, circulation solicitations, advertising or other publications in connection with ACC. Also, each of the author(s) hereby grants permission to ACC to use the manuscript in editorial research related to the improvement of editorial conduct, decision making, and issues related to peer review.
Each of the author(s) hereby releases and shall indemnify and hold harmless ACC and its successors, assigns, licensees, officers, directors, employees, and their respective heirs and representatives from and against any and all liabilities, losses, damages and expenses arising out of any claims of any kind that may be asserted against any of them based in whole or in part on any breach of the author(s)’ representations or warranties herein or in the work or anything contained in the work, including but not limited to any claims for copyright infringement or violation of any rights of privacy or publicity.