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A 7 1/2-year consecutive series is presented from a district hospital with a policy of referring all rectal carcinomas to one surgical firm. The performance of lower anterior resections has limited the rate of abdominoperineal excision with permanent colostomy to 11%. Of 115 patients in whom curative resection was attempted, 69 had anastomoses below 5 cm(More)
Five cases are described where minute foci of adenocarcinoma have been demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer. In 2 of these there was no other evidence of lymphatic spread of the tumour. In orthodox anterior resection much of this tissue remains in the pelvis, and its is suggested that these(More)
BACKGROUND Anastomotic leakage represents a major complication after anterior resection of the rectum. The incidence of anastomotic leakage varies considerably among clinical studies in part owing to the lack of a standardized definition of this complication. The aim of the present article was to propose a definition and severity grading of anastomotic(More)
OBJECTIVE To examine the role of total mesorectal excision in the management of rectal cancer. DESIGN A prospective consecutive case series. SETTING A district hospital and referral center in Basingstoke, England. PATIENTS Five hundred nineteen surgical patients with adenocarcinoma of the rectum treated for cure or palliation. INTERVENTIONS Anterior(More)
BACKGROUND The Stockholm I and II randomised trials demonstrated the value of preoperative radiotherapy in preventing local recurrence in rectal cancer. This, study investigated the potential for further improvement by introduction of the concept of total mesorectal excision (TME) to surgeons in Stockholm, Sweden. METHODS Workshops started in 1994 and(More)
Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11.0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6.4 per cent) minor leaks that were asymptomatic and detected by contrast enema.(More)
PURPOSE It is a widely held view that anterior resection (AR) for rectal cancer is an oncologically superior operation to abdominoperineal excision (APE). However, some centres have demonstrated better outcomes with APE. We conducted a systematic review of high-quality studies within the total mesorectal excision (TME) era comparing outcomes of AR and APE.(More)