RESUMO
AIMS: A prospective study was undertaken to assess the feasibility and long term results of sphincter-preserving rectal excision after preoperative radiation (35 Gy). PATIENTS AND METHODS: From 1986 to 1990, 42 patients were included in the study. Thirty four (81%) could be managed by rectal excision and stapled coloanal anastomosis. They had an adenocarcinoma located at a mean distance of 55 +/- 13 mm (range: 20-80) from the anal verge. RESULTS: Eight specimens were free of tumor. The 26 others were tabulated as follows according to the Astler-Coller staging: A = 2, B1 = 15, B2 = 5, C1 = 1, C2 = 3. The mean distal free margin was 16 +/- 11 mm (range: 1-40). The follow-up period ranged from 5 to 9 years. Six patients (18%) experienced postoperative complications including minor anastomotic leakage (n = 3), bowel obstruction (n = 2), major diarrhea requiring fecal diversion (n = 1). The functional result was good in all but 3 patients (9%) who experienced a supra anastomotic stenosis and underwent a permanent colostomy. A pelvic recurrence was observed in 5 patients (15%) after a postoperative delay ranging from 11 to 50 months. At 5 years, 17 patients (50%) were alive free of cancer, 14 (41%) of them having a good functional result without colostomy. CONCLUSION: This work demonstrates that in most cases low rectal carcinoma can be safely managed by sphincter-preserving rectal excision after preoperative radiation. It strongly suggests that the long-term pelvic recurrence rate is similar to the one observed after abdomino-perineal excision. However both procedures and patients selection must be carefully performed.
