CONSERVATIVE SURGERY FOR LOW RECTAL-CARCINOMA AFTER HIGH-DOSE RADIATION - FUNCTIONAL AND ONCOLOGIC RESULTS

Objective Using a prospective, nonrandomized study, the authors evalua ted the morbidity and functional and oncologic results of conservative surgery for cancer of the lower third of the rectum after high-dose r adiation. Summary Background Data Colo-anal anastomosis has made sphin cter conservation for low rectal carcinoma technically feasible. The l imits to conservative surgery currently are oncologic rather than tech nical. Adjuvant radiotherapy has proven its benefit in terms of region al control, with a dose relationship. Methods Since June 1990, 27 pati ents with distal rectal adenocarcinoma were treated by preoperative ra diotherapy (40 + 20 Gy delivered with three fields) and curative surge ry. The mean distance from the anal verge was 47 mm (27-57 mm), and no ne of the tumors were fixed (15 T2, 12 T3). Results Mortality and morb idity were not increased by high-dose preoperative radiation. Twenty-o ne patients underwent conservative surgery (78%-17 total proctectomies and cole-anal anastomoses, 4 trans-anal resections). After colo-anal anastomosis, all patients with colonic pouch had good results; two pat ients had moderate results and one patient had poor results after stra ight cole-anal anastomosis. With a mean follow-up of 24 months, the au thors noted 1 postoperative death, 2 disease-linked deaths, 1 controll ed regional recurrence, 2 evolutive patients with pulmonary metastases , and 21 disease-free patients. Conclusions These first results confir m the possibility of conservative surgery for low rectal carcinoma aft er high-dose radiation. A prospective, randomized trial could be induc ed to determine the real role of the 20 Gy boost on the sphincter-savi ng decision,