AIMS:To present the experiences of the Regional Comprehensive Cancer Center in Wroclaw with abdominosacral resection (ASR) carried out in low-rectal cancer patients.METHODS:Rectal cancer patients (n=294) were operated on by the same surgical team using the standardized TME technique between May 5, 1998 and February 23, 2001. Depending on the distance from the anal verge, the primary tumor was removed by means of standard abdominal resection (AR-mid- and upper-rectal cancers) or abdominosacral resection (ASR-low-rectal cancers). The patients who underwent the different operative procedures were comparable in terms of distributions of age, gender, tumor infiltration depth and regional lymph node involvement with no significant statistical difference between the groups.RESULTS:Ninety-seven cases were excluded from the analysis of survival based on exclusion criteria defined. Consequently, 197 cases were left for further analysis, including 154 patients operated on by AR and 43 who underwent ASR. AR and ASR patients did not differ significantly in terms of postoperative morbidity (11% and 14%, respectively), observed (57.1% vs. 60.4%) and relative 5-year survivals (74.3% vs. 73.2%) and the cumulative 5-year local recurrence rate (5.8% vs. 4.7%).CONCLUSION:The combined use of the modern TME technique and the "historical" abdominosacral excision of the rectum seems to give new, potentially attractive perspectives for successful surgical treatment of low-rectal cancers.

Introduction . The prognosis in rectal cancer has improved significantly with the introduction of total mesorectal excision (TME). Therapeutic results have also improved in Poland, but the survival rates are still lower and the local recurrences more frequent when compared to western countries. The aim of this study was to show that, unless improperly performed, TME might significantly improve the results of oncological treatment throughout Poland. Patients and methods . The clinical records of 370 rectal cancer patients treated surgically at Lower Silesian Oncology Center, Wroclaw between April 1st, 1998 and May 6th, 2004 were subjected to retrospective analysis. The material was divided into two groups on the basis of the surgical procedure employed: 1) TME (n=260, 70%) and 2) another (undefined) technique (n=110, 30%). The following parameters were compared between both groups: 1) the percentage of one- and five- year observed survivals, 2) the average time of survival during the initial year after surgery (in months), 3) the average time of survival during five years following surgery (in years), 4) the percentage of five-year relative survivals, and 5) the percentage of isolated local recurrences demonstrated during five years following the surgery. Results . The study has shown that both the average survival times during a five-year follow-up and the rates of five-year relative survival were significantly better in the series of TME-operated patients, as compared to those who underwent other type of rectal surgery. Fifty-seven patients who underwent TME had achieved five year survival, which corresponds to 63.3% and 81.6% of observed and relative survivals, respectively. In contrast, in the group operated by a non-TME technique, the percentages of observed and relative five-year survival amounted to 36.7% and 45.5%, respectively. Moreover, isolated local recurrence developed in 6.7% of the TME-treated patients only, which contrasted with 23% observed in the group in which the old approach was used. Conclusion . Our study proves that TME is the most important and reliable determinant of survival in rectal cancer patients and the implementation of the technique as a national standard is strongly advisable in Poland.