[Spincter preservation after selective chemoradiotherapy of rectal cancer. Interim results of the OCUM study].
BACKGROUND
In a prospective multicenter observational study (OCUM) neoadjuvant chemoradiotherapy (nRCT) was selectively administered depending on the risk of local recurrence and based on the distance between tumor and mesorectal fascia in pretherapeutic high-resolution magnetic resonance imaging (MRI).


OBJECTIVE
Frequency and quality of abdominoperineal excision (APE) and sphincter preserving operations.


METHODS
Of 642 patients treated in 13 hospitals 389 received surgery alone and 253 nRCT followed by surgery. By univariate and multivariate analysis risk factors for APE were determined. Quality parameters were the quality grade of mesorectal excision, the pathohistological involvement of the circumferential resection margin and intraoperative local dissemination of tumor cells.


CONCLUSIONS
In 12.8 % of the patients APE was performed. Independent risk factors for APE were tumor location in the lower third of the rectum and the individual hospitals, where APE varied between 0 and 32 %. This variation was chiefly caused by the different case mix. Hospitals with a high APE rate (> 30 %) treated significantly more patients with very low lying carcinomas (< 3 cm above the anal verge) and more advanced tumors. The median height of the tumor in cases of APE was nearly equal in all participating hospitals. Independent on the number of cases the quality of rectal surgery was high. Within the patient groups of primary surgery and nRCT the oncological quality parameter did not significantly differ between sphincter preservation and APE. As far as sphincter preservation is concerned the results justify a selective application of nRCT in patients with rectal carcinoma. The long-term results still have to be awaited.
Chirurgische Klinik, Städtisches Klinikum, Karlsruhe, Deutschland.
J
J
Baral
Chirurgische Klinik, Städtisches Klinikum, Karlsruhe, Deutschland.
M R
MR
Schön
Klinik Neuperlach, Klinik für Allgemein- und Viszeralchirurgie, Endokrine Chirurgie und Coloproktologie, Städtische Kliniken München, München, Deutschland.
R
R
Ruppert
Klinik für Chirurgie, Carl-Thiem-Klinik, Cottbus, Deutschland.
H
H
Ptok
Abteilung für Allgemein- und Viszeralchirurgie, Vivantes-Klinik im Friedrichshain, Berlin, Deutschland.
J
J
Strassburg
Chirurgische Klinik, Kantonspital Liestal, Liestal, Schweiz.
P
P
Brosi
Chirurgische Klinik I, Charité Campus Benjamin Franklin, Berlin, Deutschland.
M E
ME
Kreis
Allgemein- und Viszeralchirurgie, Sanaklinikum Berlin Lichtenberg, Berlin, Deutschland.
A
A
Lewin
Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Klinikum Arnsberg, Arnsberg, Deutschland.
J
J
Sauer
Franziskus Hospital Bielefeld, Bielefeld, Deutschland.
S
S
Sawicki
Klinik für Allgemein-, Unfall- Viszeral- und Plastische Chirurgie, Ev. Krankenhaus Lippstadt, Lippstadt, Deutschland.
L
L
Schiffmann
Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie und Proktologie, Klinikum Herford, Herford, Deutschland.
G
G
Winde
Klinik für Allgemein- und Abdominalchirurgie, Universitätsmedizin Mainz, Langenbeckstr.1, 55131, Mainz, Deutschland. junginger@uni-mainz.de.
T
T
Junginger
Chirurgische Klinik, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Deutschland.
S
S
Merkel
Chirurgische Klinik, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Deutschland.
P
P
Hermanek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009926:Organ Preservation; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D012307:Risk Factors
Abdominoperineal resection; Neoadjuvant chemoradiotherapy; OCUM study; Rectal carcinoma; Sphincter preservation