Abstract
The present study assesses the choice of surgical procedure, oncologic results and quality of life (QOL) outcomes in a retrospective cohort of 53 patients with low-lying rectal cancers (within 6 cm of the anal verge) treated surgically following preoperative radiotherapy (RT, median dose 45 Gy) with or without concomitant 5-fluorouracil. QOL was assessed in 23 patients by using two questionnaires developed by the QOL Study Group of the European Organization for Research and Treatment of Cancer: EORTC QLQ-C30 and EORTC QLQ-CR38. After a median interval of 29 days from completion of RT, abdominoperineal resection (APR) was performed in 29 patients (55%), low anterior resection in 23 patients (20 with coloanal anastomosis) and transrectal excision in one patient. The 3-year actuarial overall survival and locoregional control rates were 71.4% and 77.5% respectively, with no differences observed between patients operated by APR or restorative procedures. For all scales of EORTC QLQ-C30 and EORTC QLQ-CR38, no significant differences in median scores were observed between the two surgical groups. Although patients having had APR tended to report a lower body image score (P = 0.12) and more sexual dysfunction in male patients, all APR patients tended to report better physical function, future perspective and global QOL. In conclusion, sphincter-sparing surgery after preoperative RT seems to be feasible, in routine practice, in a significant proportion of low rectal cancers without compromising the oncologic results. However, prospective studies are mandatory to confirm this finding and to clarify the putative QOL advantages of sphincter-conserving approaches. © 2000 Cancer Research Campaign
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB and de Haes JC (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. Natl Cancer Inst 85: 365–376
Allal AS (1996) Cancer du bas rectum: vers une approche thérapeutique integrant la radiothérapie. Bull Cancer 83: 189–196
Berger C, de Muret A, Garaud P, Chapet S, Bourlier P, Reynaud-Bougnoux A, Dorval E, de Calan L, Huten N, le Floch O and Calais G (1997) Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications. Int J Radiat Oncol Biol Phys 37: 619–627
Billingham RP (1992) Conservative treatment of rectal cancer. Cancer 70: 1355–1363
Dahlberg M, Glemelius B, Graf W and Pahlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 41: 543–549
Friedmann P, Garb JL, McCabe DP, Chabot JR, Park WC, Stark A, Coe NP and Page DW (1987) Intestinal anastomosis after preoperative radiation therapy for carcinoma of the rectum. Surg Gynecol Obstet 164: 257–260
Frigell A, Ottander M, Stenbeck H and Pahlman L (1990) Quality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma. Ann Chir Gynaecol 79: 26–30
Grann A, Minsky BD, Cohen AM, Saltz L, Guillem JG, Paty PB, Kelsen DP, Kemeny N, Ilson D and Bass-Loeb J (1997) Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum 40: 515–522
Heald RJ and Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16: 848–857
Heald RJ and Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1: 1479–1482
Hyams DM, Mamounas EP, Petrelli N, Rockette H, Jones J, Wieand HS, Deutsch M, Wickerham L, Fisher B and Wolmark N (1997) A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03. Dis Colon Rectum 40: 131–139
Kaplan EL and Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481
Klee M, Groenvold M and Machin D (1997) Quality of life of Danish women: population-based norms of the EORTC QLQ-C30. Qual Life Res 6: 27–34
Lewis WG, Williamson ME, Kuzu A, Stephenson BM, Holdsworth PJ, Finan PJ, Ash D and Johnston D (1995) Potential disadvantages of post-operative adjuvant radiotherapy after anterior resection for rectal cancer: a pilot study of sphincter function, rectal capacity and clinical outcome. Int J Colorectal Dis 10: 133–137
Lundby L, Jensen VJ, Overgaard J and Laurberg S (1997) Long-term colorectal function after postoperative radiotherapy for colorectal cancer [letter]. Lancet 350: 564
MacDonald LD and Anderson AR (1985) The health of rectal cancer patients in the community. Eur J Surg Oncol 11: 235–241
Maas CP, Moriya Y, Steup WH, Kiebert GM, Kranenbarg WM and van de Velde CJ (1998) Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 85: 92–97
Maghfoor I, Wilkes J, Kuvshinoff B, Westgate S, Bryer M and Perry MC (1997) Neoadjuvant chemoradiotherapy with sphincter-sparing surgery for low-lying rectal cancer. Proceedings of ASCO. J Clin Oncol 16: 274(Abstract)
Marks G, Mohiuddin M and Masoni L (1993) The reality of radical sphincter preservation surgery for cancer of the distal 3 cm of rectum following high-dose radiation. Int J Radiat Oncol Biol Phys 27: 779–783
Marquis R, Lasry JC, Heppell J, Potvin C, Falardeau M and Robidoux A (1992) Quality of life of patients after restorative surgery for cancer of the rectum. Ann Chir 46: 830–838
Minsky BD, Cohen AM, Enker WE and Paty P (1995) Sphincter preservation with preoperative radiation therapy and coloanal anastomosis. Int J Radiat Oncol Biol Phys 31: 553–559
Mohiuddin M, Regine WF, Marks GJ and Marks JW (1998) High-dose preoperative radiation and the challenge of sphincter-preservation surgery for cancer of the distal 2 cm of the rectum. Int J Radiat Oncol Biol Phys 40: 569–574
Papillon J and Gérard JP (1990) Role of radiation therapy in anal preservation for cancers of the lower third of the rectum. Int J Radiat Oncol Biol Phys 19: 1219–1220
Perez CA and Brady LW (1992) Overview. In: Principles and Practice of Radiation Oncology, 2nd edn, Perez CA and Brady LW (eds), pp. 51–55, Lippincott: Philadelphia
Pollett WG and Nicholls RJ (1983) The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 198: 159–163
Quirke P, Durdey P, Dixon MF and Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histological study of lateral tumour spread and surgical excision. Lancet 2: 996–999
Rouanet P, Fabre JM, Dubois JB, Dravet F, Saint Aubert B, Pradel J, Ychou M, Solassol C and Pujol H (1995) Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic results. Ann Surg 221: 67–73
Sprangers MA, Taal BG, Aaronson NK and te Velde A (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38: 361–369
Sprangers MAG, te Velde A and Aaronson NK on behalf of the European Organization for Research and Treatment of Cancer Study Group on Quality of Life (1999) The construction and testing of the EORTC Colorectal Cancer Specific Quality-of-Life questionnaire Module (the QLQ-CR38). Eur J Cancer (in press)
Williams NS, Dixon MF and Johnston D (1983) Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg 70: 150–154
Williams NS and Johnston D (1983) The quality of life after rectal excision for low rectal cancer. Br J Surg 70: 460–462
Wirsching M, Druner HU and Herrmann G (1975) Results of psychosocial adjustment to long-term colostomy. Psychother Psychosom 26: 245–256
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Allal, A., Bieri, S., Pelloni, A. et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 82, 1131–1137 (2000). https://doi.org/10.1054/bjoc.1999.1052
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1054/bjoc.1999.1052
Keywords
This article is cited by
-
Long-term effect of neoadjuvant radiotherapy in patients with locally advanced rectal mucinous adenocarcinoma: a population-based study of 1514 patients
Scientific Reports (2023)
-
Long-term Effect of Radiotherapy in Rectal Cancer Patients with Mucinous Tumor: A Large Population Based Study
Scientific Reports (2017)
-
Quality of life in rectal cancer patients after radical surgery: a survey of Chinese patients
World Journal of Surgical Oncology (2014)
-
Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision
Surgical Endoscopy (2014)
-
Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications
International Journal of Colorectal Disease (2013)