Comparison of Curativity and Quality of Life between Low Anterior Resection and Rectal Amputation for Rectal Cancer

Low anterior resection (LAR, 67 cases) or rectal amputation (APR, 106 cases) was performed on 173 patients with rectal cancer. The postoperative 5-year cumulative survival rates were 63.2% for LAR and 70.1% for APR for stage I-III cancer, but 28.6% for LAR and 50.4% for APR for stage N cancer. Thus, APR was superior to LAR in curativity of advanced rectal cancer. Postoperative urinary dysfunction occurred in 30.0% of the LAR cases and in 52.6% of the APR cases. Erection and ejaculation dysfunctions occurred in 30.8% and 46.2% of the LAR cases, and in 77.5% and 79.5% of the APR cases, respectively. The incidence of these dysfunctions was increased by dissecting intrapelvic lateral lymph nodes in both groups. These results reveal that the postoperative quality of life is influenced by different operative methods and the extent of lymph-adenectomy. Preoperatively, we analyzed the nuclear DNA contents of rectal cancer by flow cytometry and the depth of cancerous invasion in the rectal wall by endoscopic ultrasonography. Preoperative staging for rectal cancer was useful for the determination of a limited operation for early cancer and the improvement of the quality of life. We should choose a curative operation with extended lymphadenectomy for advanced cancer.