gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Sphincter preservation after pre-operative chemo-radiotherapy in patients with low rectal cancer

Meeting Abstract

  • corresponding author presenting/speaker Manuel Besendörfer - Department of Surgery, Universityhospital Erlangen, Deutschland
  • G. Grabenbauer - Department of Radiotherapy, Universityhospital Erlangen
  • K. Matzel - Department of Surgery, Universityhospital Erlangen
  • W. Hohenberger - Department of Surgery, Universityhospital Erlangen

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO606

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Veröffentlicht: 20. März 2006

© 2006 Besendörfer et al.
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Introdution: Standard therapy for patients with low rectal cancers is the abdominoperineal resection (APR), in cases where for oncological purposes a low anterior resection (LAR) or intershinctere resectin is not possible. Although oncological results are comparable, the permanent colostomy means a loss of quality of life for the patient. After introduction of preoperativ chemo–radiotherapy in patients with low rectal cancer there were cases where a preservation of the anal sphincter was possible, in which after the first staging an abdominoperineal resection (APR) after preoperative chemo-radiotherapy can be lowered.

Material and Method: Between 1995 and 2002 in Erlangen 49 patients with low rectal cancer (0-6 cm from linea anocutaneo), which were not included in other studies were treated with preoperative chemo-radiotherapy. The preoperativ tumor stage of these patients was c/u T3+ and/or c/u N+. The lower rectum was divided into 3 parts (0-2 cm, 2-4 cm and 4-6 cm from linea anocutaneo). In 15 patients the tumor was between 0 and 2 cm. 9 Patients with a high local tumor stage (T4) were treated preoperatively with the intenton of a curative (R0)resection. In these two groups no sphincter preservation was possible. In 25 patients we undertook a preoperative chemo-radiotreatment with the purpose of sphincter preservation. The used operation techniques were the low anterior- (LAR), the intersphinctere (ISR)- and the abdominoperineal rectum resection (APR).

Results: The tumor-hight from 6 patients was between 4 and 6 cm. In this group there was no (0 %) abdominoperineal resection (APR). 4 patients (67 %) had an intersphinctere- (ISR) and 2 patients (33 %) a low anterior resection. In the group between 2 and 4 cm were 19 patients with preoperative treatment. An abdominoperineal resection (APR) was necessary in 6 patients (32 %). 9 patients (47 %) had an intersphinctere- (ISR) and 4 patients (21 %) a low anterior resection.

Conclusion: A preoperative chemo-radiotherapy should be discussed as a possibility for sphincter preservation in the treatment of low rectal cancer.