The surgical treatment of cancer of the middle rectum is still controversial. Several surgical procedures were retrospectively assessed in 90 patients operated from February 1990 to June 1997. Of these, 43 (47.7%) patients were females and 47 (52.3%) males. Age ranged from 20 to 90 years (mean,60.2 years). The main symptoms were tenesmus and straining, passage of blood and lost of weight. The time between the begining of the symptoms and the diagnosis ranged from two to 24 months (mean, 7.5 months). Abdominoperineal resection was done in 17 patients and the main complication was perineal dehiscence occuring in 47% of cases. One patient was submmited to total proctocolectomy. Hartmann procedure was done in 26 patients with 7.6% morbidity and 7.6% mortality caused by clinical complications. Twenty six patients had resection followed by anastomosis. 1n ten cases hand anastomosis had normal course without complications. In others 16, mechanical anastomosis was done with three dehiscences and one death related to clinical complications. Pull-through operation with coloanal anastomosis was done in eight patients with 50% complications, due to necrosis and retraction of the colon stump. One death occurred related to surgical complication. In 12 cases tumor resection was not done because the precarious condition of these patients. We conclude that the best procedure in cancer of the middle rectum depends of efficient evaluation considering the cell differentiation degree. the metastasis existence, the local condition of the tumor the clinical state of the patient and the experience of the surgeon.
Cancer; Middle rectum; Surgery