Preoperative radiochemotherapy and sphincter-saving resection for T3 XXXX of the lower third of the rectum.

@entity1 @entity137 @entity5 @entity75 @entity294 @entity189 @entity292 @entity1410 @entity1487
OBJECTIVE: To evaluate the complications and oncologic and functional results of preoperative radiochemotherapy and sphincter-saving resection for T3 @entity5 of the lower third of the rectum. SUMMARY BACKGROUND DATA: @entity189 of the lower third of the rectum (i.e., located at or below 6 cm from the anal verge) are usually treated by abdominoperineal resection, especially for @entity75 . Few data are available evaluating concomitant chemotherapy with preoperative radiotherapy for increasing sphincter-saving resection in low @entity5 . METHODS: Between 1995 and 1999, 43 @entity1 underwent preoperative radiochemotherapy with conservative surgery for a low @entity5 located a mean of 4.5 cm from the anal verge (range 2-6); 70% of the lesions were less than 2 cm from the anal sphincter. There were 40 T3 and 3 T4 @entity5 . @entity1 received preoperative radiotherapy with a mean dose of 50 Gy (range 40-54) and concomitant chemotherapy with @entity1487 in continuous infusion (n = 36) or bolus (n = 7). Sphincter- saving resection was performed 6 weeks after treatment, in 25 @entity1 by using intersphincteric resection. Coloanal anastomoses were associated with a colonic pouch in 86% of the @entity1 , and all @entity1 had a protecting stoma. RESULTS: There were no deaths related to preoperative radiochemotherapy and surgery. Acute @entity137 was mainly due to @entity294 , with 54% of grade 1 to 2. Four anastomotic @entity292 and two pelvic @entity1410 occurred; all @entity1 but one had closure of the stoma. Distal and radial surgical margins were respectively 23 +/- 8 mm (range 10-40) and 8 +/- 4 mm (range 1-20) and were negative in 98% of the @entity1 . Downstaging (pT0-2N0) was observed in 42% of the @entity1 (18/43) and was associated with a greater radial margin (10 vs. 6 mm; P =.02). After a median follow-up of 30 months, the rate of local recurrence was 2% (1/43), and four @entity1 had distal metastases. Overall and disease-free survival rates were both 85% at 3 years. Functional results were good (Kirwan continence I, II) in 79% of the available @entity1 (n = 37). They were slightly altered by intersphincteric resection (57 vs. 75% of perfect continence; NS) but were significantly improved by a colonic pouch (74 vs. 16%; P =.01). CONCLUSIONS: These results suggest that preoperative radiochemotherapy allowed sphincter-saving resection to be performed with good local control and good functional results in @entity1 with @entity5 that would have required abdominoperineal resection in most instances.
