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Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis
Author(s) -
LunaPérez Pedro,
RodríguezRamírez Saúl,
HernándezPacheco Freddi,
Gutiérrez de la Barrera Marcos,
Fernández Raúl,
Labastida Sonia
Publication year - 2003
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.10185
Subject(s) - coloanal anastomosis , medicine , anal verge , surgery , abdominoperineal resection , anastomosis , colorectal surgery , rectum , sphincter , adenocarcinoma , colorectal cancer , cancer , abdominal surgery
Background and Objectives Standard treatment of rectal adenocarcinoma located 3–6 cm above anal verge is abdominoperineal resection. The objective was to evaluate feasibility, morbidity, and functional results of anal sphincter preservation after preoperative chemoradiation therapy and coloanal anastomosis in patients with rectal adenocarcinoma located between 3 and 6 cm above the anal verge. Methods This study included 17 males and 15 females with a mean age of 54.8 ± 15.4 years. Tumors were located at a mean of 4.7 ± 1.1 cm above the anal verge. The mean tumor size was 4.6 ± 1.5 cm. All patients received the scheduled treatment. Twenty‐two patients underwent coloanal anastomosis with the J pouch; 10 underwent straight anastomosis. Average surgical time was 328.7 ± 43.8 min, and the average intraoperative hemorrhage was 471.5 ± 363.6 ml. The mean distal surgical margin was 1.3 ± 0.6 cm. Five patients (15.6%) received a blood transfusion. Results Major complications included coloanal anastomotic leakage (three); pelvic abscess (three), and coloanal stenosis (two). Tumor stages were as follows: T0–2,N0,M0 = 12; T3,N0,M0 = 9; T1–3,N+,M0 = 9, and T1–3,N0–3,M+ = 2. Diverting stomas were closed in 30 patients. Median follow‐up was 25 months. Recurrences occurred in four patients and were local and distant (n = 1) and distant (n = 3). Anal sphincter function was perfect (n = 20), incontinent to gas (n = 3), occasional minor leak (n = 2), frequent major soiling (n = 3), and colostomy (n = 2). Conclusions In patients with locally advanced rectal cancer located 3–6 cm from anal verge who are traditionally treated with abdominoperineal resection, preservation of anal sphincter after preoperative chemoradiation therapy plus complete rectal excision with coloanal anastomosis is feasible and is associated with acceptable morbidity and no mortality. J. Surg. Oncol. 2003;82:3–9. © 2002 Wiley‐Liss, Inc.