Outcomes in the surgical treatment of low rectal cancer: does neoadjuvant treatment equalize results?

Background The choice of operation for potentially curable cancer of the low rectum (≤6 cm from the anal verge) is usually between ultra low anterior resection ( ULAR ) or abdominal perineal excision ( APE ). Numerous studies have suggested improved results with ULAR . Methods This study was a retrospective review of prospectively collected data for a series of patients undergoing surgical treatment for low rectal cancer at three M elbourne hospitals. The patient details and outcomes were compared between those undergoing APE and ULAR . Results One hundred and ninety‐eight of 213 patients with potentially curable low rectal cancer were treated by either ULAR ( n = 82) or APE ( n = 116). Overall survival and local recurrence rates were similar, although there was a trend towards improved results for ULAR . Preoperative radiation was received by 89 (76.7%) of APE patients and 44 (53.7%) of ULAR patients ( P < 0.0005). Conclusion In this study there was no statistical difference in the oncological results between APE and ULAR . However, there was a trend to improved result for ULAR in spite of a strikingly higher rate of neoadjuvant radiation in the APE group. It is possible that enhanced use of preoperative radiation has a beneficial role in the management of low rectal cancer treated by conventional APE .