Preoperative staging of rectal cancer allows selection of patients for preoperative radiotherapy

Background: Variability in rates of local recurrence following resection of rectal cancer has led to the suggestion that all patients should undergo p reoperative radiotherapy. This centre employs a selective policy of radioth erapy only in patients with evidence of advanced local disease determined b y preoperative staging. Methods: A retrospective review was carried out of 114 consecutive patients with rectal cancer. Patients were divided before operation into palliative and curative,groups based on preoperative staging. Only patients in the pa lliative group were offered preoperative radiotherapy. Total mesorectal exc ision (TME) was performed for all tumours of the middle or lower rectum. Results: The perioperative mortality rate was 0.9 per cent and anastomotic dehiscence occurred in 2.8 per cent. Local recurrence developed in 4 per ce nt of patients in the 'curative' group and in seven of 15 of those assigned to the palliative group before operation (P < 0.01). Positive lateral rese ction margins were significantly associated with a risk of subsequent recur rence (ten of 13 versus three (3 per cent) of 93; P < 0.001). Conclusion: Preoperative adjuvant radiotherapy can be omitted reasonably in patients in whom there is no evidence of locally advanced disease, provide d that adequate surgery, incorporating TME for low tumours, is performed.