Conservative surgery for low rectal carcinoma after high-dose radiation : functional and oncologic results

• Published in: Annals of surgery Vol. 221; no. 1; pp. 67 - 73
• Main Authors: ROUANET, P, FABRE, J. M, DUBOIS, J. B, DRAVET, F, SAINT AUBERT, B, PRADEL, J, YCHOU, M, SOLASSOL, C, PUJOL, H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 1995
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Aged; Biological and medical sciences; Combined Modality Therapy; Female; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Radiotherapy Dosage; Rectal Neoplasms - mortality; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Human; Rectal disease; Conservative surgery; Carcinoma; Treatment; Rectum; Digestive diseases; Evolution; Radiotherapy; High dose
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199501000-00008

Using a prospective, nonrandomized study, the authors evaluated the morbidity and functional and oncologic results of conservative surgery for cancer of the lower third of the rectum after high-dose radiation.
Colo-anal anastomosis has made sphincter conservation for low rectal carcinoma technically feasible. The limits to conservative surgery currently are oncologic rather than technical. Adjuvant radiotherapy has proven its benefit in terms of regional control, with a dose relationship.
Since June 1990, 27 patients with distal rectal adenocarcinoma were treated by preoperative radiotherapy (40 + 20 Gy delivered with three fields) and curative surgery. The mean distance from the anal verge was 47 mm (27-57 mm), and none of the tumors were fixed (15 T2, 12 T3).
Mortality and morbidity were not increased by high-dose preoperative radiation. Twenty-one patients underwent conservative surgery (78%-17 total proctectomies and colo-anal anastomoses, 4 trans-anal resections). After colo-anal anastomosis, all patients with colonic pouch had good results; two patients had moderate results and one patient had poor results after straight colo-anal anastomosis. With a mean follow-up of 24 months, the authors noted 1 postoperative death, 2 disease-linked deaths, 1 controlled regional recurrence, 2 evolutive patients with pulmonary metastases, and 21 disease-free patients.
These first results confirm the possibility of conservative surgery for low rectal carcinoma after high-dose radiation. A prospective, randomized trial could be induced to determine the real role of the 20 Gy boost on the sphincter-saving decision.