Preoperative Chemoradiation Therapy in the Management of Locally Advanced Rectal Cancer

PURPOSE: Surgery is the standard care in the treatment of rectal cancer. However, after surgery alone, local recurrence and distant metastasis remain high for locally advanced rectal cancer. Preoperative chemoradiation therapy (pre-CRT) has been thought to be effective for increasing resectability and decreasing the rate of local recurrence for locally advanced rectal cancer. This study was designed to assess the efficacy of preoperative concurrent chemoradiation therapy in the management of locally advanced rectal cancer. METHODS: Between July 1999 and December 2003, 29 patients had locally advanced rectal cancer (uT3/ T4, uN1 by endorectal ultrasonography) or were ineligible to undergo sphincter-preserving surgery. All patients were treated with pre-CRT, followed by surgery in 25 patients. Patients were treated with radiation therapy with a total dose of 45~50.4 Gy to the surgical bed and pelvic lymph- node area for 5.5 weeks. We analyzed the degree of toxicity and the therapeutic resopnse from CRT, the type of surgery, including sphincter-saving procedures, and the mid- term outcome. RESULTS: Of the 29 patients who received pre-CRT, a radical resection was possible in 25 patients. A low anterior resection and an ultra-low anterior resection- coloanal anastomosis were performed in 13 (52%) and 7 (28%) cases, respectively. Sphincter-preserving surgery was performed in 80% of the patients. The postoperative pathological response rates of CRT were 25% complete remission, 45% partial remission, 30% no response. Postoperative complications and toxicity from CRT were acceptable. The duration of median follow-up was 24 months (9~62 months). Recurrence was seen in 6 cases. Distant recurrence alone was seen in 5 patients (19.2%) and distant and local recurrences were seen in only one patient (4%). The 3-year overall survival rate was 72.4%, and 3-year disease-free survival rate was 59.5%. CONCLUSION: Our data suggested that preoperative concurrent CRT therapy for locally advanced rectal cancer is safe and tolerable. These data showed a high local control rate and a high 3-year survival rate. Preoperative CRT was an effective modality for sphincter preservation in selected patients who would have required an abdominoperineal resection. Additional studies with larger numbers of patients and long-term follow up are warranted to confirm our results. In addition, more effective chemotherapeutic regimens are needed to decrease distant metastasis.

The Effect of Old Age on the Development of Postoperative Complication in Surgery for Gastric Carcinoma

PURPOSE: Despite the fact that the number of elderly in the population has increased due to the improvement in medical skills and equipment and an increased interest in health, there is a view common among patients, guardians, and even the surgeons that the prognosis after surgery in the elderly is not optimistic. We examined the effect of old age on the prognosis after surgery in patients who were to undergo surgery after being diagnosed with gastric cancer. The effect of old age on the development of postoperative complications was evaluated. METHOD: Five hundred and seventy three patients, who underwent surgery for gastric cancer from January 1994 to December 1998 at Wonju Christian Hospital under Yonsei University Wonju College of Medicine, were analyzed retrospectively. The patients were divided into those older and younger 70 years of age. The presence of an underlying disease, the physical condition according to ASA(American Society of Anesthesiologist) classification, the extent of the resection, the TNM stage according to the AJCC (American Joint Committee on Cancer), and the operation time were examined. The effects of age on the postoperative complications in the study and control groups were also evaluated. RESULTS: Among the 573 patients, 515 were under 70 years and 58 were older than 70. Those older than 70 years, showed significant differences with physical condition (P<0.001), the presence of an underlying disease (P=0.043), M stage of TNM staging (P=0.001), hospital days (P<0.001), and operation time (P=0.026). CONCLUSION: Age itself did not correlate with the development of postoperative complications (P=0.193). The presence of an underlying disease affected the development of postoperative complications regardless of age or gender. Therefore, surgery can be performed safely when the patient's condition is evaluated thoroughly before surgery and the operation is carried out as scheduled.