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World Journal of Surgery

, Volume 39, Issue 5, pp 1248–1256 | Cite as

Changing Operative Strategy from Abdominoperineal Resection to Sphincter Preservation in T3 Low Rectal Cancer after Downstaging by Neoadjuvant Chemoradiation: A Preliminary Report

  • Khaled M. Madbouly
  • Ahmed M. Hussein
Original Scientific Report

Abstract

Objective

The objective of this study is to assess oncological outcome after changing operative strategy from abdominoperineal resection (APR) to sphincter preservation (SP) in T3 low rectal carcinomas downstaged by neoadjuvant chemoradiation (nCRT).

Patients and Methods

This was a prospective observational study performed at academic medical centers. Patients with T3 rectal carcinoma, (<1 cm from the top of anal sphincter) received long-course neoadjuvant chemoradiation. Decision before chemoradiation was APR in all patients. Patients who had successful downstaging were included in the study. Low anterior resection (LAR) was performed after 8–11 weeks from completion of nCRT. Follow-up duration ranged from 4 to 6 years. Salvage surgery was done for local recurrence when possible. The primary endpoint of the study was disease-free survival. Secondary endpoints were morbidity, mortality, continence, and oncologic results of salvage surgery after recurrence.

Results

LAR with colorectal or coloanal anastomosis were done in 9 and 36 patients, respectively. After a mean follow-up of 57 months (range 48–70), local recurrences was reported in 4 patients (8.8 %), one of them had also distant metastasis while 2 patients (4.4 %) had only distant metastasis. Disease-free and overall survival rates were 87 and 89 %, respectively. Three of 4 patients with local recurrence (the fourth had liver metastasis) underwent salvage APR with free safety margins. Follow-up after salvage surgery for 31, 33, and 37 months revealed no recurrences. Wexner continence score ≤4 was noted in 39 patients; while major incontinence (Wexner score >12) was noted in 2 patients.

Conclusions

For selected patients of T3 low rectal cancer, changing operative strategy from APR to SP after downstaging by nCRT can be done in motivated patients with good sphincter function. Disease-free survival rates and continence are comparable to patients had APR and to previous publications with decision made before nCRT. With strict follow-up, early diagnosis of recurrence and salvage surgery with free resection margins can be achieved.

Keywords

Complete Pathologic Response Abdominoperineal Resection Operative Strategy Pelvic Magnetic Resonance Imaging Permanent Stoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

No financial support was received for this study.

Conflict of interest

Authors have no conflict of interest related to this article.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of AlexandriaAlexandriaEgypt

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