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Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
Author(s) -
Rouanet Philippe,
Rivoire Michel,
Gourgou Sophie,
Lelong Bernard,
Rullier Eric,
Jafari Merhdad,
Mineur Laurent,
Pocard Marc,
Faucheron Jean Luc,
Dravet François,
Pezet Denis,
Fabre Jean Michel,
Bresler Laurent,
Balosso Jacques,
Taoum Christophe,
Lemanski Claire
Publication year - 2021
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.26249
Subject(s) - medicine , abdominoperineal resection , surgery , randomized controlled trial , randomization , rectal carcinoma , radiation therapy , colorectal cancer , sphincter , carcinoma , cancer
Background Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra‐low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10‐year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR). Methods ULRC indicated for APR were included ( n = 207). Randomization was between high‐dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection. Results Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10‐year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease‐free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%). Conclusion GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long‐term oncologic follow‐up validates this attitude.