Conservative treatment of carcinomas of the anorectal junction by preoperative radiotherapy and intersphincteric resection.

Aim: Adenocarcinomas of the anorectal junction, especially T3 lesions, are usually treated by abdominoperineal resection. The aim of this study was to evaluate oncologic and functional results following conservative radiosurg ical treatment of cancers of the anorectal junction, Methods: From 1990 to 1999, among 395 patients with rectal carcinoma, 31 ha d sphincter-saving resection for a tumour located between 2 to 4.5 cm (mean 3.6) from the anal verge. There were 16 men and 15 women, mean age 62 year s (range 30-86). There were 5 T2, 23 T3 and 3 T4 tumours; 17 were N1 and 3 were M1. Preoperative radiotherapy was performed in 26 patients (dose: 46 G y, range: 36-54), with concomitant chemotherapy in 14 cases. Intersphincter ic resection was performed six weeks after neoadjuvant treatment. Coloanal anastomoses were associated with a colonic pouch in 22 cases and with a pro tecting stoma in all cases. Results: There was no postoperative mortality. Seven complications occurred : 3 anastomotic fistulas, 3 pelvic haemorrhages and 1 acute pancreatitis. T hree patients had a definitive stoma. After preoperative radiotherapy, down -staging (pTO-2 NO) occurred in 46% of cases (12/26). Distal margin was 2.2 cm (range: 1-3) and was microscopically safe in all cases. Lateral margin was safe (greater than or equal to 1 mm) in 97% of cases. With a mean follo w-up of 36 months, no local recurrence was suspected. Twenty-six patients ( 84%) were alive, 23 free of disease. Half of the patients had perfect conti nence, whereas the other half had occasional minor soiling. Functional resu lts were better in patients with a colonic pouch. Conclusion: Conservative treatment of carcinomas of the anorectal junction is possible without compromising pelvic control and patient survival. Pelvi c control was probably achieved by using preoperative radiotherapy with int ersphincteric resection, ensuring safe distal and lateral margins. (C) 2000 Editions scientifiques et medicales Elsevier SAS.