Preoperative chemoradiation and coloanal J pouch reconstruction for low rectal cancer

Our objective was to determine clinical outcomes of treatment of low rectal adenocarcinoma with neoadjuvant chemoradiation, rectal excision, and coloa nal J pouch reconstruction. A retrospective review of 69 patients with stag e B2 or higher lesions was performed. Preoperative chemoradiation was follo wed by low anterior resection and coloanal J pouch anastomosis, with end lo op ileostomy, Data were analyzed using the SPSS computer software. There we re 46 males and 23 females, with a median age of 63 years. Pathologic stagi ng showed no tumor in the specimen, i.e.: stage 0, 14 per cent; stage A, 14 per cent; stage B, 53 per cent; stage C,18 per cent; and stage D, 1.4 per cent. Postoperative mortality was 2.8 per cent, and the pelvic leak rate wa s 4.3 per cent. After curative resection, 89 per cent patients are alive an d 83 per cent are disease free with a mean follow-up of 50 months. The loca l recurrence rate is 7.2 per cent. Nodal status was the most important pred ictor of survival and disease-free survival. Most (96%) have fewer than two bowel movements a day and are satisfied with the functional results. We co nclude that preoperative chemoradiation and coloanal J pouch reconstruction can achieve low recurrence rates and prolonged survival for most patients with low rectal cancer with an acceptable quality of life.