[Treatment of low rectal cancer by conservative rectal resection after preoperative irradiation. Long term results and prospective study].
OBJECTIVE
A prospective study was undertaken to assess the feasibility and long term results of sphincter-preserving rectal excision after preoperative radiation (35 Gy).


METHODS
From 1986 to 1990, 42 patients were included in the study. Thirty four (81%) could be managed by rectal excision and stapled coloanal anastomosis. They had an adenocarcinoma located at a mean distance of 55 +/- 13 mm (range: 20-80) from the anal verge.


RESULTS
Eight specimens were free of tumor. The 26 others were tabulated as follows according to the Astler-Coller staging: A = 2, B1 = 15, B2 = 5, C1 = 1, C2 = 3. The mean distal free margin was 16 +/- 11 mm (range: 1-40). The follow-up period ranged from 5 to 9 years. Six patients (18%) experienced postoperative complications including minor anastomotic leakage (n = 3), bowel obstruction (n = 2), major diarrhea requiring fecal diversion (n = 1). The functional result was good in all but 3 patients (9%) who experienced a supra anastomotic stenosis and underwent a permanent colostomy. A pelvic recurrence was observed in 5 patients (15%) after a postoperative delay ranging from 11 to 50 months. At 5 years, 17 patients (50%) were alive free of cancer, 14 (41%) of them having a good functional result without colostomy.


CONCLUSIONS
This work demonstrates that in most cases low rectal carcinoma can be safely managed by sphincter-preserving rectal excision after preoperative radiation. It strongly suggests that the long-term pelvic recurrence rate is similar to the one observed after abdomino-perineal excision. However both procedures and patients selection must be carefully performed.
Gouillat
C
C
Département de Chirurgie, Hôtel Dieu, Lyon.
Bérard
P
P
Chavatte
P Y
PY
Ain
J F
JF
Manganas
D
D
D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*