Incidence of local recurrence after curative operations for cancer of the rectum.

Between January 1, 1969 and December 31, 1979 a total of 248 patients with infiltrative carcinoma of the middle third of the rectum were treated curatively either by sphincter saving anterior resection (176/248) or by abdomino-perineal excision (72/248). The observed incidence of local recurrence was 21% (52/248). Among the tumor specific factors which influence the development of local recurrence the type of growth (insular - circular, exophytic - ulcerous) and the presence of lymph node metastases at the time of the primary operation proved to be statistically significant. Among the surgical factors a sufficient distal margin of safety in anterior resection could be shown to be of major importance. In order to minimize the risk of local recurrence the distal margin of safety should be at least three cm determined in the fresh operative specimen without tension. The type of operation, be it abdomino-perineal excision or anterior resection, has no influence on the incidence of local recurrence as long as a sufficient distal margin of safety is achieved during anterior resection.