Rectal cancer threatening or affecting the prostatic plane: is partial prostatectomy oncologically adequate? Results of a multicentre retrospective study.
OBJECTIVE
The management of rectal cancer threatening or affecting the prostatic plane is still under debate. The role of preoperative chemo radiotherapy and the extent of prostatectomy seem to be key points in the treatment of these tumours. The aim of the present study was to evaluate the pathological circumferential margin status and the local recurrence rate following different therapeutic options.


METHODS
A multicentre, retrospective study was conducted of patients with rectal cancer threatening or affecting the prostatic plane, but not the bladder, judged by magnetic resonance imaging (MRI). The use of preoperative chemoradiotherapy and the type of urologic resection were correlated with the status of the pathological circumferential resection margin (CRM) and local recurrence.


RESULTS
A consecutive series of 126 men with rectal cancer threatening (44) or affecting (82) the prostatic plane on preoperative staging and operated with local curative intent between 1998 and 2010 was analysed. In patients who did not have chemoradiotherapy but had a preoperative threatened anterior margin the CRM-positive rate was 25.0%. In patients who did not have preoperative chemoradiotherapy but did have an affected margin, the CRM-positive rate was 41.7%. When preoperative radiotherapy was given, the respective CRM infiltration rates were 7.1 and 20.7%. In patients having preoperative chemoradiotherapy followed by prostatic resection the rate of CRM positivity was 2.4%. Partial prostatectomy after preoperative chemoradiotherapy resulted in a free anterior CRM in all cases, but intra-operative urethral damage occurred in 36.4% of patients who underwent partial prostatectomy, resulting in a postoperative urinary fistula in 18.2% of patients.


CONCLUSIONS
Preoperative chemoradiation is mandatory in male patients with a threatened or affected anterior circumferential margin on preoperative MRI. In patients with preoperative prostatic infiltration, prostatic resection is necessary. In this group of patients partial prostatectomy seems to be oncologically safe.
Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain.
M
M
Frasson
Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain.
E
E
Garcia-Granero
Colorectal Unit, Department of General Surgery, Complejo Hospitalario Universitario de Ourense, Ourense, Spain.
A
A
Parajó
Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain.
L
L
Garcia-Mayor
Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain.
B
B
Flor
Spanish Association of Coloproctology (AECP), Bellvitge University Hospital and Valle de Hebron University Hospital, Barcelona, Spain.
A
A
Garcia-Granero
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
I
I
Lavery
D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D014521:Urethra / Q000293:injuries; D014548:Urinary Fistula / Q000209:etiology*
Rectal cancer; locally advanced; multivisceral resection; partial prostatectomy; preoperative radiotherapy; prostate