Treatment of low rectal carcinoma by Sphincter-saving rectal excision after preoperative radiation. Long-term results of a prospective study.

Aims - A prospective study was undertaken to assess the feasibility and lon g term results of sphincter-preserving rectal excision after preoperative r adiation (35 Gy). Patients and methods - From 1986 to 1990, 42 patients were included in the study Thirty four (81 %) could be managed by rectal excision and stapled co loanal anastomosis. They had an adenocarcinoma located at a mean distance o f 55 +/- 13 mm (range: 20-80) from the anal verge. Results - Eight specimens were free of tumor: The 26 others were tabulated as follows according to the Astler-Coller staging: A = 2, B1 = 15 B2 = 5 C1 = 1, C2 = 3. The mean distal free margin was 16 +/- 11 mm (range: 1-40). T he follow-up period ranged from 5 to 9 yeats. Six patients (18 %) experienc ed postoperative complications including minor anastomotic leakage (n = 3), bowel obstruction (n = 21, major diarrhea requiring fecal diversion (n = 1 ). The functional result was good in all but 3 patients (9 %) who experienc ed a supra anastomotic stenosis and underwent a permanent colostomy A pelvi c recurrence was observed in 5 patients (15 %) after a postoperative delay ranging from 11 to 50 months. At 5 pears, 17 patients (50 %) were alive fre e of cancer 14 (41 %) of them having a good functional result without colos tomy. Conclusion - This work demonstrates that in most cases low rectal carcinoma can be safely managed by sphincter-preserving rectal excision after preope rative radiation. It strongly suggests that the long-term pelvic recurrence rare is similar to the one observed after abdomino-perineal excision. Howe ver both procedures and patients selection must be carefully performed.