ADENOCARCINOMA OF THE RECTUM. CLINICAL CHARACTERISTICS AND THERAPEUTIC APPROOCH. STUDY OF 49 CASES.

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Published Mar 31, 2010
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Vol. 88 No. 4 (2010): Issue Apr 2010

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A.N GORDAH
A HLALI
M ELGHOUL
M KHALIFA
M.H MANAI
M ESSOUSSI

Abstract

Aim of the study : Adenocarcinoma represents the main histological form of the rectal cancers. The purpose of this retrospective study is to describe the epidemiological and clinical profile of our patients who have a rectal adenocarcinoma and to evaluate our therapeutic approach to this pathology.
Patients and methods : This is a retrospective study including 49 cases of rectal adenocarcinoma in patients hospitalized in the service of general surgery of the military hospital of Tunis between January 1996 and December 2006.We included in this study all the patients who has a rectal adenocarcinoma situated at less than 15 cm of the anal border and excluded those situated at the recto-sigmoid junction.
Results : This series involved 32 men and 17 women. Sex ratio was 1.88 and mean age 56.6 years. Recta bleeding represented the chief complaint. It was observed in 45 patients (91.8%). Average duration between the onset of clinical symptoms and diagnosis was 6.3 months. Tumor was situated in the lower rectum in 34.8% of cases, in the middle rectum in 43.5% of cases and in the higher rectum in 21.7% of cases. Forty-five patients (91.8%) were operated on ; 20 conservative operations and 20 radical operations in which we had to sacrifice the anal sphincter, were performed. Radiation therapy was given to 60% of patients. Colostomy was done in 5 patients only. Morbidity was estimated at 55% in patients who underwent abdominosacral resection. This morbidity consisted mainly of urinary disorders and thrombo-embolisms. Morbidity was about 30% in patients who had had an anterior resection, dominated by anastomotic fistulae (20%). Global morbidity due to rectal resection was about 42.7%. Mortality was estimated at 2.5%. The rate of local recurrences in the patients who underwent curatvo surgery was 22.8%. The frequency of metachron metastasis was about 31.4%. The frequency of local recurrences and metastases was thus estimated at 37.1%.
Conclusion : This series is characterized by the predominance of men. Rectal bleeding represented the chief complaint. Although our series covered many years, it was characterized by coherent surgical indications and a high big number of patients who benefited from preoperative radiation therapy. Morbidity and mortality were as whole acceptable as they were in agreement with the published data.

Keywords:

adenocarcinoma of the rectum, diagnosis, traitment

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