Stapled Anterior Resection of the Rectum for Rectal Cancer – A 10-year Experience at a Tertiary Hospital in Southern Nigeria

Abstract

Background: Anterior resection is the surgical treatment of proximal and mid-rectal cancers. The procedure is technically challenging and anastomotic leak is a devastating complication. The use of stapling devices to achieve the colorectal anastomosis is desirable by many surgeons. The objective of the study was to describe the experience of stapled anterior resection of the rectum for rectal cancer at the University of Benin Teaching Hospital, a tertiary center in southern Nigeria in the past 10 years.

Methods: The case files of patients who had stapled anterior resection at the University of Benin Teaching Hospital from January, 2016 to December, 2015 were retrieved and relevant data entered into a proforma and presented in tables.

Results: Sixteen cases of stapled anterior resection were done; the records of 2 patients were incomplete. The median age of the 14 cases analyzed was 53 years with an age range of 28 to 72 years. The male to female ratio was 1:1. Alteration in bowel habit in favour of constipation was the most common presentation occurring in 11 patients (78.6%). Passage of blood per rectum was reported in 9 patients (64.3%). The distance of the tumour from the anal verge ranged from 7cm to 16cm. Histology was invasive adenocarcinoma in all the cases and the lungs and liver were the common sites of metastatic disease. Four patients (28.6%) had neo-adjuvant chemotherapy while all patients had adjuvant chemotherapy. Surgery was done in 100% of cases under combined spinal and epidural anaesthesia. Two patients (14.3%) had tumour recurrence necessitating abdominoperineal resection of the rectum and permanent colostomy. Another 2 patients (14.3%) had low output faecal fistula which healed following non-operative treatment. Average duration of hospital stay was 11.8 days.

Conclusion: stapled anterior resection is a safe procedure for the treatment of proximal rectal cancer