SPHINCTER PRESERVATION SURGERY FOR RECTAL-CANCER UTILIZING HIGH-DOSE PREOPERATIVE RADIATION - THE THOMAS-JEFFERSON-UNIVERSITY-HOSPITAL EXPERIENCE

Among 181 patients included from February 1976 to April 1990 in a prospective study for rectal carcinoma, 143 underwent pre-operative radiationtherapy (45 to 60 Gy) followed by a curative radical rectal resection and colo-anal or low colorectal anastomosis. There was no operative mortality. Five pelvic infections, 3 major anastomotic disruptions and 2 significant strictures occurred. The Kaplan-Meier actuarial survival was 80 % for the entire group of 143, 71 % for the 96 unfavourable post radiation stages B2, C1 and C2. Local recurrence was observed in 15 of 117 patients (13 %) followed for 2 years or longer, in 14 of 86 patients (16 %) with cancer at or below the 6 cm level (from the anorectal ring) and in 6 of 43 patients (14 %) among those with tumours below 4 cm. The authors conclude that radical resection with sphincter preservation for rectal cancer can be accomplished safely when preceded by high-dose radiation. The use of pre-operative radiation can reduce considerably the incidence of local recurrence and allows preservation of sphincter function in low rectal cancer.