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Clinical Trial
. 2021 Jan;123(1):299-310.
doi: 10.1002/jso.26249. Epub 2020 Oct 24.

Sphincter-saving surgery for ultra-low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long-term follow-up?

Philippe Rouanet  1 , Michel Rivoire  2 , Sophie Gourgou  3 , Bernard Lelong  4 , Eric Rullier  5 , Merhdad Jafari  6 , Laurent Mineur  7 , Marc Pocard  8 , Jean Luc Faucheron  9 , François Dravet  10 , Denis Pezet  11 , Jean Michel Fabre  12 , Laurent Bresler  13 , Jacques Balosso  14 , Christophe Taoum  1 , Claire Lemanski  15
Affiliations
Clinical Trial

Sphincter-saving surgery for ultra-low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long-term follow-up?

Philippe Rouanet et al. J Surg Oncol. 2021 Jan.

Abstract

Background: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).

Methods: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection.

Results: Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).

Conclusion: GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.

Keywords: intersphincteric resection; neoadjuvant radiotherapy; sphincter saving surgery; ultra low rectal carcinoma.

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References

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