2005 Abstracts: Preoperative Chemoradiation Therapy and Sphincter-Saving Operations for Distal Rectal Cancer: Is There Still Place for Abdominal-Perineal Resection?
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Preoperative Chemoradiation Therapy and Sphincter-Saving Operations for Distal Rectal Cancer: Is There Still Place for Abdominal-Perineal Resection?
Angelita Habr-Gama, University of Sao Paulo Colorectal SurgeryDivision, Sao Paulo, SP, Brazil; Rodrigo O. Perez, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, SP, Brazil; Afonso H. Sousa, Sylvio F. Bocchinni, University of Sao Paulo Colorectal Surgery Division, Sao Paulo, SP, Brazil; Igor Proscurshim, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, sp, Brazil; Desiderio R. Kiss, University of Sao Paulo Colorectal Surgery Division, Sao Paulo, SP, Brazil; Joaquim Gama-Rodrigues, University of Sao Paulo Surgery of the Alimentary Tract Division, Sao Paulo, SP, Brazil
Objective: Sphincter preservation is a serious concern in the management of distal rectal cancer. Preoperative chemoradiation therapy (CRT) has lead to significant tumor downstaging and higher rates of sphincter-saving operations (SSO). However, the impact of the type of operation performed in outcome has not yet been determined. We compared results of patients treated by APR (abdominal-perineal resection) or SSO for distal rectal cancer following CRT.
Patients and Methods: 180 patients with resectable, distal rectal adenocarcinoma treated by preoperative CRT (5FU, Leucovorin and 50.4 Gy) were reviewed. Operations included APR or SSO at the surgeon's discretion. Patients treated by APR were compared to patients treated by SSO in terms of clinical-pathological features, recurrence and survival. Results: 81 patients were managed by SSO while 99 were managed APR. Patients treated by APR had significantly lower tumors (p<0.001), greater final tumor size (p=0.008), greater distal margins (p=0.006) and higher rates of perineural and angio/lymphatic invasion (p<0.02). These latter pathological features were associated with significantly worse disease-free survival (p=0.0001). Overall and disease-free survival showed no statistical differences between APR or SSO. Mean follow-up was 43 mo. (APR) and 49 (SSO) mo. Conclusions: APR is the standard operation for distal rectal cancer and is associated with good results even in the presence of poor prognostic pathological features. The performance of SSO even in the presence of good prognostic pathological features is not associated with improved outcome when compared to APR.
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