Treatment of cancer of the rectum
A principle of surgical management in past years was to employ one operation for one disease with little regard for variations in manifestations of the disease in different patients. Cancers of the rectum were treated by abdominoperineal resection, regardless of the size of the tumor, its configuration, or its specific location in the rectum. This may have been because most cancers were large and involved the rectum extensively. Today, smaller cancers of the rectum are seen more frequently, and the extent of involvement is less. It is therefore appropriate that a less extensive operation than the traditional abdominoperineal resection be employed for treatment.
For many years at the Cleveland Clinic, electroexcision-electrocoagulation has been used in the treatment of selected patients with cancer of the rectum. During this period of time, abdominoperineal resection has continued to be employed at the same institution for the majority of patients with cancer of the rectum. Dr. George Crile, Jr. of the Department of General Surgery compared the results of these two methods of therapy during the years from 1952 to 1966.1
Abdominoperineal resection was used for the treatment of 226 patients (220 of whom were available for 5-year follow-up); 62 patients were treated by the local operation (all were available for 5-year follow-up). Forty-six percent of the 220 patients treated by abdominoperineal resection were alive 5 years after the operation, and 68% of the locally treated group were alive after 5 years. Seven of the 220 patients and 5 of the 62 patients were. . .