title: Sphincter-preserving R0 total mesorectal excision with resection of internal genitalia combined with pre- or postoperative chemoradiation for T4 rectal cancer in females.
abstract: OBJECTIVE
  To evaluate the impact of chemoradiation admi-nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter-preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables.
  
  
  METHODS
  Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log-rank test. The association between chemoradiation and other variables was evaluated with the Fisher's exact test and Mann-Whitney test.
  
  
  RESULTS
  Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located<or=7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P=0.03 and 80.0% vs 27.3%; P=0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss>or=1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P<0.01).
  
  
  CONCLUSIONS
  Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.
authors.affiliation: 2nd Department of Surgical Oncology, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, and Department of Gynaecological Oncology, Wroclaw Medical University, Poland. szynglarewicz.b@dco.com.pl
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Szynglarewicz
authors.forename: Rafal
authors.initials: R
authors.lastname: Matkowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Kasprzak
authors.forename: Daniel
authors.initials: D
authors.lastname: Sydor
authors.forename: Jozef
authors.initials: J
authors.lastname: Forgacz
authors.forename: Marek
authors.initials: M
authors.lastname: Pudelko
authors.forename: Jan
authors.initials: J
authors.lastname: Kornafel
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000628:therapy*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome