Transabdominal transanal resection of distal rectal cancer after high dose preoperative radiotherapy: a Chinese experience in preserving sphincter function

Abstract

Background: The combination of high dose preoperative radiotherapy and transanal abdominal transanal radical proctosigmoidectomy and colo-anal anastomosis as a sphincter-preserving method has never been performed in mainland China.

Objectives: To assess the feasibility and efficacy of high dose preoperative radiotherapy and TATA as a sphincter-preserving method in Jiangsu, an economically well-developed region of China with a population of 70 million people.

Methods: From September 1994 to September 2000, 25 consecutive patients with pathologically confirmed distal rectal adenocarcinoma were treated preoperatively with a total dose of 45-46 Gy at 1.8-2.0 Gy per fraction during 5 weeks. Sphincter-preserving surgery by TATA was performed 4-6 weeks after radiotherapy.

Results: Acute toxicity of preoperative radiotherapy was tolerable. Eight percent of the patients presented pathologic complete tumor response after preoperative radiotherapy. All patients underwent TATA as scheduled. During a median follow-up of 70 months, the 5 year survival rate was 88%. The 5 year survival rate for those tumors down-staged to pathological TO or to pT1 was 100%.

Conclusions: High dose preoperative radiotherapy and TATA as a sphincter-preserving method was feasible and efficient in Chinese patients with distal rectal cancer. In this study, the subset of patients with a good response to radiotherapy had a better clinical outcome.