One hundred eighty-six consecutive abdominoperineal resections for primary carcinoma of the anus, rectum, or sigmoid colon performed at Charity Hospital of Louisiana at New Orleans between January 1, 1963 and December 31, 1974 were reviewed. The operative mortality was 16 per cent. Complications during the same hospitalization occurred in 70 per cent of the patients. Although most of the complications were minor, 22 per cent did require some form of surgical intervention. Twenty-nine per cent of the patients who were discharged developed late mechanical or cancer-caused complications which required surgical correction. A history of congestive heart failure or a significant weight loss were the most consistent preoperative findings in the operative mortality group. The overall five year survival rate was 25 per cent. White females with no history of weight loss had the best long-term prognosis. Better survival in white patients can be accounted for by the less advanced lesions in these patients. No such difference between male and female patients could be demonstrated. Better selection of surgical candidates with alternate forms of therapy for poor risk patients have probably been the most significant factors in decreasing the operative mortality from 21 per cent in the first six years of the study to 9 per cent in the last six years. Primary closure of the perineal wound would appear to be of value in decreasing operative morbidity.
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