title: Influence of the neo-adjuvant radiochemotherapy as a factor in the surgical treatment of rectal cancer by expert surgeon. A comparative study.
abstract: OBJECTIVE
  Total mesorectal excision and surgeon experience are prognostic factors in rectal cancer surgery, in terms of local recurrence and conservative sphincter surgery. Pre-operative radiation-chemotherapy can even improve those results. The aim of this study is to assess the utility of pre-operative radiation therapy (PRT) on the results of surgical treatment for rectal cancer comparing two consecutive series of patients operated on by surgeons with experience in rectal cancer surgery according to whether they had received PRT.
  
  
  METHODS
  Retrospective review of 118 patients with rectal cancer, divided into two groups: group I, 57 patients without pre-operative radiation-chemotherapy, and group II, 61 patients with rectal cancer who received pre-operative radiation-chemotherapy. Both groups were homogeneous. The short-term results (surgical technique, post-operative stay, post-operative complications) and long-term results (local recurrences, liver metastases and both overall and tumour-related survival) were analysed.
  
  
  RESULTS
  The rate of anterior resection in the lower third was significantly higher (p = 0.037) in group II than in group I (56 vs 23%), the rate of abdominoperineal resection in the middle third was significantly lower (p = 0.046) in group II (3.5 vs 21%). The incidence of post-operative complications was similar in both groups, but the rate of anastomotic leaks was higher in group II. The local recurrences was lower in group II (p = 0.002), but the disease free survival and the overall survival was similar in both groups. At the multivariate analysis, the only prognostic factor for the local recurrence was the use of pre-operative radiation-chemotherapy.
  
  
  CONCLUSIONS
  Besides surgeon experience and total mesorectal excision, a very important prognostic factor is the administration of pre-operative radiation-chemotherapy in cases of locally advanced rectal cancer, as it does not increase post-operative morbidity and mortality and significantly influences the rate of local recurrences and the conservative sphincter surgery.
authors.affiliation: Department of General Surgery, Virgen de la Arrixaca Hospital University, University of Murcia, Murcia, Spain. gracivalero@yahoo.es
authors.forename: G Valero
authors.initials: GV
authors.lastname: Navarro
authors.forename: J A Luján
authors.initials: JA
authors.lastname: Mompeán
authors.forename: Q Hernández
authors.initials: QH
authors.lastname: Agüera
authors.forename: D Pérez
authors.initials: DP
authors.lastname: Flores
authors.forename: D Frutos
authors.initials: DF
authors.lastname: Bernal
authors.forename: J Gil
authors.initials: JG
authors.lastname: Martínez
authors.forename: P Parrilla
authors.initials: PP
authors.lastname: Paricio
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents