Is there an alternative approach to abdominoperineal resection for the treatment of very low lying rectal cancer? Five-year results.
OBJECTIVE
To investigate whether sphincter-saving surgery combined with preoperative radiotherapy and postoperative adjuvant chemotherapy can compare successfully with abdominoperineal resection in the treatment of very low lying rectal cancer.


METHODS
Two groups of patients were studied. Group I included 65 patients (T2-3 N0-2 M0) with very low lying rectal cancer treated since 1995 by a sphincter- saving surgical procedure. All of them received preoperatively external radiotherapy and postoperatively adjuvant chemotherapy with 5-fluorouracil (5-FU) and folinic acid. This group was prospectively evaluated. Group II included 122 patients with the same tumor stage and location as Group I, who were treated by abdominoperineal resection and were retrospectively evaluated. The rate of local recurrence was compared between the two groups.


RESULTS
In Group I patients the local recurrence rate was 13.84% (9 patients) for a period ranging from 6 months to the end of the second year after the operation. This group of patients were followed up to 60 months after the initial treatment. The local recurrence rate in Group II patients was 17.21% (21 patients; p >0.05).


CONCLUSIONS
We consider that sphincter-preserving surgery combined with preoperative radiotherapy and postoperative adjuvant chemotherapy represents a successful alternative to abdominoperineal resection of very low lying rectal adenocarcinoma.
Kurtev
P
P
National Center of Oncology, Sofia, Bulgaria.
Dimitrov
V
V
Kurteva
G
G
Klenova
A
A