Perioperative outcomes after ultra low anterior resection in the era of neoadjuvant chemoradiotherapy.
OBJECTIVE
Data on perioperative outcomes of sphincter preserving ultra low anterior resections (ULAR) following neoadjuvant chemoradiotherapy (NA-CTRT) is sparsely reported in literature.


METHODS
Prospective data of 68 patients was reviewed retrospectively. Patients who received preoperative chemoradiotherapy (CTRT, Group A, n = 45) were compared with those who were operated upfront (Group B, n = 23).


RESULTS
Overall, mean distance of the tumor from anal verge was 5.1 cm (range 3-8). In Groups A and B, it was 5.2 and 5.1 cm, respectively. In Group A, 3 patients had complete response, 40 had partial response and 2 had progressive disease. Overall, the mean distance of the anastomosis performed from the anal verge was 2.8 cm (range 1-4). In Groups A and B, it was 2.7 and 2.9 cm, respectively (NS). Mean blood loss in Groups A and B was 510.5 (range 200-2,200) and 345 mL (range 50-800), respectively (p = 0.037). Two patients in Group A required blood transfusion (range 1-2) compared to none in Group B. The overall complication rate was 26.5 % (18/68); in Groups A and B, it was 22.2 % and 34.8 %, respectively. There was no postoperative mortality. Postoperative stay for Groups A and B was 8 and 9.5 days (p = 0.009), respectively. In Group A, 23/45 patients, earlier planned for abdominoperineal resection, ultimately received sphincter-preserving ULAR.


CONCLUSIONS
ULAR can be performed safely without added morbidity or mortality after neoadjuvant chemoradiation. In some cases, earlier deemed to be suitable for APR, the neoadjuvant approach improved chances of sphincter conservation.
Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Centre, Dr. Ernest Borges Marg, Parel, Mumbai 400 012, India. shailushrikhande@hotmail.com
Shailesh V
SV
Shrikhande
Yashodhan D
YD
Bodhankar
Kunal
K
Suradkar
Mahesh
M
Goel
Parul J
PJ
Shukla
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001810:Blood Volume; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult