title: Restorative and nonrestorative surgery for low rectal cancer after high-dose radiation: long-term oncologic and functional results.
abstract: OBJECTIVE
  This prospective, nonrandomized study evaluates, with a seven-year median follow-up, the morbidity and the functional and oncologic results of conservative surgery after high-dose radiation for cancer of the lower third of the rectum of patients who would otherwise have undergone abdominoperineal resection.
  
  
  METHODS
  Between June 1990 and June 1996, 43 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 50 (range, 25-60) mm, and none of the tumors was fixed (15 percent T2N0, 53 percent T3N0, 32 percent T3N1).
  
  
  RESULTS
  Postoperative mortality (2 percent) and morbidity (35 percent) were not increased by high-dose preoperative radiation. Conservative surgery was done in 30 patients (70 percent: 26 coloanal anastomoses and 4 low stapled anastomoses). After conservative surgery, long-term functional results showed 30 percent complete continence and 20 percent serious incontinence. Four patients had local recurrence as first development (13 percent). The seven-year overall survival rate was 53 percent, 62 percent after conservative surgery and 31 percent after abdominoperineal resection. The univariate analysis underscores the tumor response impact on long-term survival (pT<3 = 81 percent; pT3 = 35 percent; P = 0.0008).
  
  
  CONCLUSIONS
  These long-term results confirm the feasibility of conservative surgery for low rectal carcinoma after high-dose radiation. A prospective multicentric trial began in France in June 1996 to evaluate the reproducibility of these results.
authors.affiliation: Department of Surgery, Montpellier Cancer Institute, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouanet
authors.forename: Bernard
authors.initials: B
authors.lastname: Saint-Aubert
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.forename: Pierre
authors.initials: P
authors.lastname: Senesse
authors.forename: Sophie
authors.initials: S
authors.lastname: Gourgou
authors.forename: Francois
authors.initials: F
authors.lastname: Quenet
authors.forename: Marc
authors.initials: M
authors.lastname: Ycholu
authors.forename: Andre
authors.initials: A
authors.lastname: Kramar
authors.forename: JeanBernard
authors.initials: J
authors.lastname: Dubois
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D020127:Recovery of Function / Q000502:physiology*; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology* / Q000528:radiation effects / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors