Role of pre‐operative irradiation for anal preservation in cancer of the low rectum

• Published in: World journal of surgery 1992-05, Vol.16 (3), p.502-509
• Main Authors: Berard, Ph, Papillon, J.
• Format: Article
• Language: English
• Subjects: Abdominoperineal Resection; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Anal Canal; Anal Preservation; Biological and medical sciences; Cual; Diseases of the digestive system; Follow-Up Studies; Humans; Medical sciences; Mese; Neoplasm Staging; Operative Specimen; Postoperative Complications; Preoperative Care - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF02104455

Since 1979, 157 patients with T2, T3, or T4 cancer of the lower rectum have been treated by a short course of irradiation, 30 Gy within 12 days by cobalt 60 using 120° arc rotation on a sacral field, followed by a 2‐month rest before surgery. The operative specimens were tumor‐free in 13% of patients, Dukes' A in 40% of patients, Dukes' B in 22% of patients, and Dukes' C in 25% of patients. Three (1.9%) patients died postoperatively. At 3 years (107 patients) and 5 years (74 patients) the rates of death of local failure were 7.5% and 9.5%, respectively. The 3‐year and 5‐year disease‐free survival were 71% and 58%. Since 1983, the surgeons took advantage of the tumor regression to carry out sphincter‐saving operation in 67 patients with T2, T3, and T4 tumors of the lower third of the rectum. The proportion of patients treated by restorative surgery instead of abdominoperineal resection has grown significantly during the past 4 years, from 22% to 71%. Diverting colostomy was performed in 10 patients. Anastomotic leakages were observed in 7 patients. Of 31 patients who underwent low anterior resection and were followed 3 to 7 years (mean 4.5 years), 5 patients died of distant metastasis and 3 patients are alive after segmental hepatectomy. One patient had local recurrence which was controlled by abdominoperineal resection. The rate of 3‐year disease‐free survival was 77%. Preliminary results indicate that well planned pre‐operative irradiation and delayed surgery can significantly extend the scope of anal preservation for selected patients with cancer of the lower third of the rectum without jeopardizing survival. Résumé Depuis 1979, 157 patients ayant un cancer du bas rectum classé T2, T3 ou T4, ont été traités d'abord par 30 Gy en 12 jours (Cobalt 60 en champ sacré rotatoire de 120°), suivi d'un repos de deux mois avant la chirurgie. Les pièces opératoires étaient “stérilisées” dans 13% des cas, ou classées Dukes A, B et C dans 40%, 22% et 25%, respectivement. Trois patients (1.9%) sont morts postopératoirement A 3 ans (107 cas) et à 5 ans (74 cas), le taux de mortalité par récidive locale était respectivement de 7.5 et 9.5%.Les taux de survie sans maladie à 3 et à 5 ans étaient respectivement de 71 et 58%. Depuis 1983, en raison de la régression tumorale obtenue, les chirurgiens ont pu réaliser des interventions avec conservation du sphincter chez 67 patients avec un cancer du tiers inférieur du rectum classé T2, T3 ou T4. La proportion de patients ayant e