Abstract
Background
Sphincter-preserving operations (SPO) for lower rectal cancer are on the rise. In the study reported here, we compared the oncologic outcomes of patients who underwent sphincter-preserving operations following preoperative chemoradiation for lower rectal cancer with the outcome for patients who underwent abdominoperineal resection (APR).
Methods
This prospective study included 87 patients who underwent proctectomy with curative intent for locally advanced rectal cancer that was located less than 6 cm from the anal verge. Forty-four patients had APR with no preoperative treatment. Forty-three patients underwent concurrent chemoradiation therapy (CCRT) consisting of preoperative 5-fluorouracil–based chemotherapy and pelvic radiation (4500–5040 cGy); this was followed 6 weeks later by surgery (SPO/CCRT). The oncologic outcomes between the two groups were compared, and factors affecting survival were evaluated.
Results
The median follow-up period was 56.2 months. The overall postoperative complication rates did not significantly differ between SPO/CCRT and APR (32.6% versus 34.2%; p = 0.879). Also, there were no significant differences in the overall recurrence rate (20.9% versus 20.5%; p = 0.956) and 5-year overall survival rate (70.8% versus 62.9%; p = 0.189) between the two groups. By multivariate analysis, only the pathologic N stage was significantly associated with overall survival (p < 0.001).
Conclusions
Sphincter-preserving operation with CCRT could be another option for the treatment of locally advanced lower rectal cancer in patients who are clinically considered for APR, with no deterioration of oncologic outcomes. For patients undergoing curative resection for lower rectal cancer, the pathologic N stage can provide valuable prognostic information about survival.
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References
Nagtegaal ID, van de Velde CJ, Marijnen CA et al (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264
Marr R, Birbeck K, Garvican J et al (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242:74–82
Andreola S, Leo E, Belli F et al (2001) Adenocarcinoma of the lower third of the rectum surgically treated with a <10-MM distal clearance: preliminary results in 35 N0 patients. Ann Surg Oncol 8:611–615
Rouanet P, Fabre JM, Dubois JB et al (1995) Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic results. Ann Surg 221:67–73
Minsky BD, Cohen AM, Enker WE et al (1995) Sphincter preservation with preoperative radiation therapy and coloanal anastomosis. Int J Radiat Oncol Biol Phys 31:553–559
Janjan NA, Khoo VS, Abbruzzese J et al (1999) Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 44:1027–1038
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
Law WL, Chu KW (2004) Abdominoperineal resection is associated with poor oncological outcome. Br J Surg 91:1493–1499
Chuwa EW, Seow-Choen F (2006) Outcomes for abdominoperineal resections are not worse than those of anterior resections. Dis Colon Rectum 49:41–49
Chiappa A, Biffi R, Zbar AP et al (2005) Results of treatment of distal rectal carcinoma since the introduction of total mesorectal excision: a single unit experience, 1994–2003. Int J Colorectal Dis 20:221–230
Dowdall JF, Maguire D, McAnena OJ (2002) Experience of surgery for rectal cancer with total mesorectal excision in a general surgical practice. Br J Surg 89:1014–1019
Fucini C, Elbetti C, Petrolo A et al (2002) Excision of the levator muscles with external sphincter preservation in the treatment of selected low T4 rectal cancers. Dis Colon Rectum 45:1697–1705
Allal AS, Bieri S, Pelloni A et al (2000) Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 82:1131–1137
Engel J, Kerr J, Schlesinger-Raab A et al (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238:203–213
Gerard A, Buyse M, Nordlinger B et al (1988) Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 208:606–614
Medich D, McGinty J, Parda D et al (2001) Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: pathologic findings and clinical implications. Dis Colon Rectum 44:1123–1128
Valentini V, Coco C, Cellini N et al (2001) Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys 51:371–383
Rullier E, Goffre B, Bonnel C et al (2001) Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg 234:633–640
Tytherleigh MG, Mortensen NJMC (2003) Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 90:922–933
Huh JW, Park YA, Sohn SK (2007) A diverting stoma is not necessary when performing a handsewn coloanal anastomosis for lower rectal cancer. Dis Colon Rectum 50:1040–1046
Wibe A, Syse A, Andersen E et al (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47:48–58
Dehni N, McFadden N, McNamara DA et al (2003) Oncologic results following abdominoperineal resection for adenocarcinoma of the low rectum. Dis Colon Rectum 46:867–874
Rubbini M, Vettorello GF, Guerrera C et al (1990) A prospective study of local recurrence after resection and low stapled anastomosis in 183 patients with rectal cancer. Dis Colon Rectum 33:117–121
Law WL, Chu KW (2002) Local recurrence following total mesorectal excision with double-stapling anastomosis for rectal cancers: analysis of risk factors. World J Surg 26:1272–1276
Guillem JG, Chessin DB, Cohen AM et al (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241:829–838
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Huh, J.W., Jung, E.J., Park, Y.A. et al. Sphincter-Preserving Operations Following Preoperative Chemoradiation: An Alternative to Abdominoperineal Resection for Lower Rectal Cancer?. World J Surg 32, 1116–1123 (2008). https://doi.org/10.1007/s00268-008-9520-1
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DOI: https://doi.org/10.1007/s00268-008-9520-1