title: Radical and local excisional methods of sphincter-sparing surgery after high-dose radiation for cancer of the distal 3 cm of the rectum.
abstract: BACKGROUND
  Despite conventional attitudes that interdict sphincter-preservation surgery (SPS) for cancers arising in the terminal 3 cm of rectum, we have selectively employed high-dose preoperative external radiation (HDPER) and either radical or local excisional SPS techniques for rectal cancer arising between the 0.5 and 3 cm levels above the anorectal ring. We have reported a preliminary experience with HDPER and full-thickness local excision (FTLE) and three different methods of radical SPS. We now describe our experience with a single method of radical excision, transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) and FTLE in conjunction with HDPER for cancers of the distal 3 cm of rectum based on specific guidelines.
  
  
  METHODS
  Since 1984, 109 patients with cancers at or below the 3 cm level have been treated with HDPER in doses of 4,500-7,000 cGy and a sphincter-preserving radical or local excision method in a prospective rectal cancer management program. Sixty-five patients (group A) underwent transanal abdominal transanal radical proctosigmoidectomy with colonal anastomosis (TATA) and 44 patients (group B) underwent FTLE.
  
  
  RESULTS
  There was one death (1%). Mean follow-up was 40 months. Local recurrence rates for groups A and B were 9 and 14%, respectively. Kaplan-Meier 5-year actuarial survival was 85 and 90% for groups A and B, respectively, and 87% collectively.
  
  
  CONCLUSIONS
  Experience with 109 patients with cancers of the distal 3 cm of rectum indicates that SPS can be accomplished by either radical or local excisional methods with acceptable local control and survival if HDPER and strict selection guidelines are employed.
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Bannon
authors.forename: G J
authors.initials: GJ
authors.lastname: Marks
authors.forename: M
authors.initials: M
authors.lastname: Mohiuddin
authors.forename: J
authors.initials: J
authors.lastname: Rakinic
authors.forename: N Z
authors.initials: NZ
authors.lastname: Jian
authors.forename: D
authors.initials: D
authors.lastname: Nagle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D003082:Colectomy / Q000379:methods*; D003125:Colostomy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome