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Radical and local excisional methods of sphincter-sparing surgery after high-dose radiation for cancer of the distal 3 cm of the rectum

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Abstract

Background: Despite conventional attitudes that interdict sphincter-preservation surgery (SPS) for cancers arising in the terminal 3 cm of rectum, we have selectively employed high-dose preoperative external radiation (HDPER) and either radical or local excisional SPS techniques for rectal cancer arising between the 0.5 and 3 cm levels above the anorectal ring. We have reported a preliminary experience with HDPER and full-thickness local excision (FTLE) and three different methods of radical SPS. We now describe our experience with a single method of radical excision, transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) and FTLE in conjunction with HDPER for cancers of the distal 3 cm of rectum based on specific guidelines.

Methods: Since 1984, 109 patients with cancers at or below the 3 cm level have been treated with HDPER in doses of 4,500–7,000 cGy and a sphincter-preserving radical or local excision method in a prospective rectal cancer management program. Sixty-five patients (group A) underwent transanal abdominal transanal radical proctosigmoidectomy with coloanal anastomosis (TATA) and 44 patients (group B) underwent FTLE.

Results: There was one death (1%). Mean follow-up was 40 months. Local recurrence rates for groups A and B were 9 and 14%, respectively. Kaplan-Meier 5-year actuarial survival was 85 and 90% for groups A and B, respectively, and 87% collectively.

Conclusion: Experience with 109 patients with cancers of the distal 3 cm of rectum indicates that SPS can be accomplished by either radical or local excisional methods with acceptable local control and survival if HDPER and strict selection guidelines are employed.

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Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, The Comprehensive Rectal Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

    J. P. Bannon MD,  Gerald J. Marks MD, Jan Rakinic MD & Deborah Nagle MD

  2. Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky

    Mohammed Mohiuddin MD

  3. Department of General Surgery, Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, P.R. China

    Jian Nong-Zhou MD

Authors
  1. J. P. Bannon MD
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  2. Gerald J. Marks MD
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  3. Mohammed Mohiuddin MD
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  4. Jan Rakinic MD
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  5. Jian Nong-Zhou MD
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  6. Deborah Nagle MD
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Bannon, J.P., Marks, G.J., Mohiuddin, M. et al. Radical and local excisional methods of sphincter-sparing surgery after high-dose radiation for cancer of the distal 3 cm of the rectum. Annals of Surgical Oncology 2, 221–227 (1995). https://doi.org/10.1007/BF02307027

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  • DOI: https://doi.org/10.1007/BF02307027

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