SPHINCTER PRESERVATION THERAPY FOR DISTAL RECTAL-CARCINOMA - A REVIEW

BACKGROUND. There has been increasing interest in the use of sphincter -preserving therapy for patients with distal rectal carcinomas. The ou tcomes of conservative treatments for early stage rectal carcinoma app ear to be comparable to that achieved with abdominoperineal resection. METHODS. Retrospective and prospective clinical series of patients wi th distal rectal carcinoma treated by local excision alone, local exci sion with postoperative adjuvant therapy, preoperative radiation follo wed by local excision, or radical circumferential sphincter-sparing su rgeries were reviewed. The local control rates, salvage rates, and tre atment complications in patients treated by these various methods were examined. RESULTS. Patients with T1 distal rectal carcinoma with favo rable clinical and histopathologic characteristics treated with local excision alone had a local control rate of greater than 90% in most se ries. Postoperative chemoradiation improved local control for those wi th T1 disease with unfavorable characteristics, or those with T2 disea se. Most T3 patients had failure rates of greater than 30% despite adj uvant local and systemic therapy. With high dose preoperative radiatio n, approximately 80% of patients with locally advanced or unresectable tumors were able to undergo sphincter-preservation treatment. CONCLUS IONS. Patients with favorable T1 rectal carcinoma are likely to be ade quately treated with local excision alone. Patients with T1 disease wi th unfavorable characteristics as well as T2 patients will benefit fro m postoperative chemoradiation. The use of local therapy in T3 patient s needs to be carefully considered because these patients are at relat ively high risk for local recurrence despite adjuvant therapy. Preoper ative radiation followed by either local excision or radical circumfer ential sphincter-sparing resections appears promising in allowing sphi ncter preservation in patients with locally advanced tumors. (C) 1997 American Cancer Society.