Premium
B001
Multicentre Randomized Trial of Sphincter Preserving Surgery for Ultra‐Low Rectal Carcinoma
Author(s) -
Rullier E.,
Rivoire M.,
Lelong B.,
Vanseymortier L.,
Mineur L.,
Pocard M.,
Lasser P.,
Faucheron J.l.,
Dravet F.,
Pezet D.,
SaintAubert B.,
Rouanet P
Publication year - 2006
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01082_1.x
Subject(s) - medicine , randomized controlled trial , surgery , radiation therapy , concomitant , colorectal cancer , sphincter , anal verge , pathological , cancer
Objective This randomized study compared two neoadjuvant treatments in patients with a low rectal cancer less than 2 cm from the anal verge that would have required APR before radiotherapy. Method A total of 207 patients (71% uT3) with a rectal carcinoma at 0.5 cm from the anal verge were randomized in two groups. The group HDR received a high dose of radiotherapy (45 Gy + boost 18 Gy). The group RCT received 45 Gy with concomitant chemotherapy (5FU). Surgery was performed 6 weeks after treatment, surgeons were trained with TME, APR and intersphincteric resection. Results The rate of sphincter preserving surgery was 83% after HDR and 86% after RCT ( P = 0.69). There was no difference in morbidity, clinical tumour regression (80% vs. 87%) and complete pathological response (8% vs. 15%) between HDR and RCT. Overall, the rate of R0 resection was 78%. After a follow‐up of 23 months, the rates of local and distant recurrence were 6% and 19% respectively and the disease‐free survival was 77%. Survival was better after sphincter preservation than after APR. Conclusion Sphincter preservation was achieved in 85% of ultra‐low rectal carcinomas without compromising oncological prinicples. No difference was observed between HDR and RCT. Further follow‐up is necessary to confirm this conservative approach.