Restorative and nonrestorative surgery for low rectal cancer after high-dose radiation: long-term oncologic and functional results.
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.
Rouanet
Philippe
P
Department of Surgery, Montpellier Cancer Institute, France.
Saint-Aubert
Bernard
B
Lemanski
Claire
C
Senesse
Pierre
P
Gourgou
Sophie
S
Quenet
Francois
F
Ycholu
Marc
M
Kramar
Andre
A
Dubois
JeanBernard
J
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