title: Outcomes in the surgical treatment of low rectal cancer: does neoadjuvant treatment equalize results?
abstract: BACKGROUND
  The choice of operation for potentially curable cancer of the low rectum (≤6 cm from the anal verge) is usually between ultra low anterior resection (ULAR) or abdominal perineal excision (APE). Numerous studies have suggested improved results with ULAR.
  
  
  METHODS
  This study was a retrospective review of prospectively collected data for a series of patients undergoing surgical treatment for low rectal cancer at three Melbourne hospitals. The patient details and outcomes were compared between those undergoing APE and ULAR.
  
  
  RESULTS
  One hundred and ninety-eight of 213 patients with potentially curable low rectal cancer were treated by either ULAR (n = 82) or APE (n = 116). Overall survival and local recurrence rates were similar, although there was a trend towards improved results for ULAR. Preoperative radiation was received by 89 (76.7%) of APE patients and 44 (53.7%) of ULAR patients (P < 0.0005).
  
  
  CONCLUSIONS
  In this study there was no statistical difference in the oncological results between APE and ULAR. However, there was a trend to improved result for ULAR in spite of a strikingly higher rate of neoadjuvant radiation in the APE group. It is possible that enhanced use of preoperative radiation has a beneficial role in the management of low rectal cancer treated by conventional APE.
authors.affiliation: Discipline of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
authors.forename: William G
authors.initials: WG
authors.lastname: Pollett
authors.forename: Peter
authors.initials: P
authors.lastname: Gibbs
authors.forename: Stephen
authors.initials: S
authors.lastname: McLaughlin
authors.forename: Jimmy
authors.initials: J
authors.lastname: Eteuati
authors.forename: Michael
authors.initials: M
authors.lastname: Harold
authors.forename: Kaye
authors.initials: K
authors.lastname: Marion
authors.forename: Shweta
authors.initials: S
authors.lastname: Patel
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010502:Perineum / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: colorectal surgery; neoadjuvant therapy; radiation treatment outcome; rectal neoplasm