Transabdominal transanal resection of distal rectal cancer after high dose preoperative radiotherapy: a Chinese experience in preserving sphincter function.
BACKGROUND
The combination of high dose preoperative radiotherapy and transanal abdominal transanal radical proctosigmoidectomy and colo-anal anastomosis as a sphincter-preserving method has never been performed in mainland China.


OBJECTIVE
To assess the feasibility and efficacy of high dose preoperative radiotherapy and TATA as a sphincter-preserving method in Jiangsu, an economically well-developed region of China with a population of 70 million people.


METHODS
From September 1994 to September 2000, 25 consecutive patients with pathologically confirmed distal rectal adenocarcinoma were treated preoperatively with a total dose of 45-46 Gy at 1.8-2.0 Gy per fraction during 5 weeks. Sphincter-preserving surgery by TATA was performed 4-6 weeks after radiotherapy.


RESULTS
Acute toxicity of preoperative radiotherapy was tolerable. Eight percent of the patients presented pathologic complete tumor response after preoperative radiotherapy. All patients underwent TATA as scheduled. During a median follow-up of 70 months, the 5 year survival rate was 88%. The 5 year survival rate for those tumors down-staged to pathological TO or to pT1 was 100%.


CONCLUSIONS
High dose preoperative radiotherapy and TATA as a sphincter-preserving method was feasible and efficient in Chinese patients with distal rectal cancer. In this study, the subset of patients with a good response to radiotherapy had a better clinical outcome.
Zhou
Jian-Nong
JN
Department of Surgery, Jiangsu Cancer Hospital and Research Institute, Nanjing, China. zhoujiannong09@yahoo.com.cn
Wang
De-Zhen
DZ
Huang
Xin-En
XE
Xu
Fa-Pei
FP
Shang
Jun-Qin
JQ
Gu
Rong-Min
RM
D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D001003:Anal Canal / Q000503:physiopathology* / Q000528:radiation effects / Q000601:surgery*; D002681:China; D003131:Combined Modality Therapy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000528:radiation effects / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome