[Oncologic and functional results of resections with direct delayed coloanal anastomosis in previously irradiated cancers of the lower rectum].
OBJECTIVE
The aim of this study was to assess the oncology and functional outcome after preoperative radiotherapy and delayed coloanal anastomosis for cancers of the lower third of the rectum.


METHODS
From January 1988 to December 1997, 35 patients received preoperative radiotherapy (45 Gy) followed by rectal resection through a combined abdominal and transanal approach. Thirty patients had preoperative tumor staging with endorectal ultrasonography: uT1N0 = 2, uT2N0 = 6, uT2N+ = 2, uT3N0 = 6, and uT3N+ = 14. Colorectal resection was performed on average 32 days after the conclusion of radiotherapy, and the distal colon stump was pulled through the anal canal. On postoperative day 5, the colonic stump was resected and a direct coloanal anastomosis performed.


RESULTS
Pathological examination of the specimens revealed complete tumor sterilization in two cases, pT1N0 = 3, pT2N0 = 14, pT2N+ = 1, pT3N0 = 6, and pT3N+ = 9. There was no postoperative mortality and there was no leakage. One patient had a pelvic abscess, and another one had left colon necrosis which required re-operation. Median follow-up was 43 months (range 6-113). Two patients had locoregional recurrence, seven had distant metastasis, and 3 had both. Actuarial survival rate at 1, 3 and 5 years was 97%, 86%, and 72% respectively. The rate of local control at 5 years was 78%. Functional results were evaluated by a new scoring system. Function was considered good in 59 and 70% at 1 and 2 years respectively.


CONCLUSIONS
This new procedure is a safe and effective sphincter-preserving operation that avoids a diverting stoma. It is well adapted for patients receiving preoperative radiotherapy, with low local morbidity and good functional results.
Baulieux
J
J
Service de chirurgie générale, digestive et de la transplantation hépatique, Hôpital de la Croix-Rousse, Lyon.
Olagne
E
E
Ducerf
C
C
De La Roche
E
E
Adham
M
M
Berthoux
N
N
Bourdeix
O
O
Gérard
J P
JP
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D003106:Colon / Q000601:surgery*; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013997:Time Factors
Résultats oncologiques et fonctionnels des résections avec anastomose coloanale directe différée dans les cancers du bas rectum préalablement irradiés.