Preoperative chemoradiation followed by transanal excision for rectal cancer.
BACKGROUND
This study was conducted to assess the efficacy of preoperative chemoradiation followed by transanal excision among patients with locally advanced lower rectal cancer.


METHODS
Between May 1994 and June 2005, 73 patients with locally advanced lower rectal cancer were treated with curative intent by preoperative chemoradiation followed by surgical resection. Transanal excision was performed in 9 patients due to either the absolute refusal of a permanent stoma by the patient (n = 8) or medical comorbidity (n = 1). Sixty-four patients were treated by radical proctectomy. Preoperative 5-fluorouracil-based chemotherapy and pelvic radiation (4500 to 5040 cGy) were followed by surgery 6 wk after treatment, and all patients except one with transanal excision received postoperative 5-fluorouracil-based chemotherapy during the first year after surgery.


RESULTS
The mean follow-up period was 91 mo (range, 50 to 127 mo); median follow-up was 94 mo. One local recurrence occurred at 30 mo after transanal excision (11.1%); 5 in 64 patients who received radical proctectomy (7.8%) experienced local recurrences. The disease-free survival rate at 10 y was 77.8% in transanal excision group compared with a rate of 62.7% among radical proctectomy patients (P = 0.335). The overall survival rate at 10 y was 88.9% in transanal excision group compared with 74.2% among radical proctectomy patients (P = 0.424).


CONCLUSIONS
Transanal excision after preoperative chemoradiation in highly-selected patients with locally advanced lower rectal cancer could probably be an acceptable alternative to conventional radical surgery. However, this approach should be prospectively validated, and strict patient selection criteria should be used.
Huh
Jung Wook
JW
Department of Surgery, Yongdong Severance Hospital, Yonsei University Health System, Seoul, Korea.
Jung
Eun Joo
EJ
Park
Yoon Ah
YA
Lee
Kang Young
KY
Sohn
Seung-Kook
SK
D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011351:Proctoscopy; D011878:Radiotherapy; D012004:Rectal Neoplasms / Q000628:therapy*; D012007:Rectum / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil