TITLE:
Sphincter Saving Surgeries for Locally Advanced Low Rectal Cancer after Neoadjuvant Chemoradiation
AUTHORS:
Mohamed A. E. Salem, Hamza A. Hamza, Gamal Amira, Abeer E. Ibrahium, Ahmed A. S. Salem
KEYWORDS:
Coloanal Pull-Through; Colo Rectal Cancer; Neoadjuvant Chemoradiation; Low Anterior Resection
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.7,
September
4,
2013
ABSTRACT: Background: Rectal cancer accounts for the largest distribution
within one anatomical region of the large bowel, with approximately one third
of all CRC located within the rectum. The Golden standard treatment of primary
rectal cancer is curative surgical resection; however, a fine balance remains
between disease cure and restoration of gastrointestinal continuity. Combined
modality has proven efficacy in many malignant tumors with advantage of organ
preservation. Methods: Forty nine (49) patients with low rectal
carcinoma were included in a prospective study, between Jan 2007 and Jan 2012.
Preoperative chemoradiation was administrated to all patients and subjected to
different techniques of sphincter saving surgery. Stage I and Stage IV disease
at diagnosis were excluded from the study. Results: Forty nine patients
were included in the study. 27 (55%) patients were male and 22 (45%) were
female; the age ranges from 23 years to 70 years with the median age 46 years. The main
presenting symptoms were bleeding per rectum and tenesmus, Stage II 18 patients (36.7%), stage III 31 patients (63.3%). Complete
clinical and pathological response in 3 patients (6%), and complete clinical
response with only microscopically residual carcinoma in 20 patients (41%),
partial response in 18 patients (36.7%), and no significant response in 8
patients (16%) 7 from 8 were mucoid carcinoma. Low anterior resection (LAR) in
22 patients (44.9%), Hartman’s procedure in 4 patients (8.1%), Coloanal pull-through (COP) was done in 19 patients
(38.9%) and perineal colostomy in 4 patients (8.1%). For patients with
colo-anal pull-through technique complete dehiscent and retraction observed in
2 cases, Major leakage in one case, stenosis in 4 cases. Conclusion: There
is tendency of colorectal cancers to affect younger groups. Most patients presented
in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter
saving surgery. Coloanal pull-through technique is not a widely spread technique for
low rectal cancer with good oncological safety and acceptable functional
outcome.