PROCTECTOMY AND COLOANAL ANASTOMOSIS AFTE R HIGH-DOSE RADIATION FOR CARCINOMA OF THE LOWER 3RD OF THE RECTUM - FUNCTIONAL AND ONCOLOGICAL RESULTS

This prospective study was designed to evaluate morbidity and function al and onological outcomes in patients with carcinoma of the distal th ird of the rectum treated by high-dose radiation therapy followed by c onservative surgery. Twenty-two patients with adenocarcinoma of the di stal third of the rectum treated after June 1990 were included in the study. Mean distances separating the tumor from the upper edge of the levator ani muscle and from the anal verge were 17 mm and 47 mm, respe ctively. None of the tumors were fixed; preoperative stage, establishe d by endoscopic ultrasound, was T2 in 12 patients and T3 in 10. Patien ts received induction radiation therapy in two series delivered three weeks apart (40 Gy on the pelvis, then 20 Gy on the tumor only) follow ed by surgical resection (proctectomy with colo-anal anastomosis in 17 cases and amputation in five). After radiation, two tumors were negat ive for malignant cells, 12 were Astler-Coller B1, two were B2, and si x were C2. Mean safety margin after colo-anal anastomosis was 16.8 mm; all the resection margins were negative. Mortality and morbidity were not increased by the high-dose radiation protocol. Conservation of th e sphincter was possible in 80% of patients. All the patients were con tinent. Functional outcome was rated good in 77% of cases, fair in 9% and poor in 4%. During the mean follow-up of 24 months, there were thr ee disease-related deaths, including one due to a strictly regional re currence; metastatic dissemination to the lungs occurred in two patien ts and the remaining 17 patients (80%) were disease-free. These data s uggest that high-dose radiation therapy followed by conservative surge ry ensures satisfactory functional outcomes in patients with carcinoma s of the distal rectum. Evaluation of oncological outcomes will requir e a longer follow-up.