RADICAL AND LOCAL EXCISIONAL METHODS OF SPHINCTER-SPARING SURGERY AFTER HIGH-DOSE RADIATION FOR CANCER OF THE DISTAL 3 CM OF THE RECTUM

Background: Despite conventional attitudes that interdict sphincter-pr eservation surgery (SPS) for cancers arising in the terminal 3 cm of r ectum, we have selectively employed high-dose preoperative external ra diation (HDPER) and either radical or local excisional SPS techniques for rectal cancer arising between the 0.5 and 3 cm levels above the an orectal ring. We have reported a preliminary experience with HDPER and full-thickness local excision (FTLE) and three different methods of r adical SPS. We now describe our experience with a single method of rad ical excision, transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) and FTLE in conjunction with HDPER for can cers of the distal 3 cm of rectum based on specific guidelines. Method s: Since 1984, 109 patients with cancers at or below the 3 cm level ha ve been treated with HDPER in doses of 4,500-7,000 cGy and a sphincter -preserving radical or local excision method in a prospective rectal c ancer management program, Sixty-five patients (group A) underwent tran sanal abdominal transanal radical proctosigmoidectomy with coloanal an astomosis (TATA) and 44 patients (group B) underwent FTLE. Results: Th ere was one death (1%). Mean follow-up was 40 months. Local recurrence rates for groups A and B were 9 and 14%, respectively, Kaplan-Meier 5 -year actuarial survival was 85 and 90% for groups A and B, respective ly, and 87% collectively. Conclusion: Experience with 109 patients wit h cancers of the distal 3 cm of rectum indicates that SPS can be accom plished by either radical or local excisional methods with acceptable local control and survival if HDPER and strict selection guidelines ar e employed.