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World J Gastroenterol. Apr 28, 2007; 13(16): 2339-2343
Published online Apr 28, 2007. doi: 10.3748/wjg.v13.i16.2339
Sphincter-preserving R0 total mesorectal excision with resection of internal genitalia combined with pre- or postoperative chemoradiation for T4 rectal cancer in females
Bartlomiej Szynglarewicz, Rafal Matkowski, Piotr Kasprzak, Daniel Sydor, Jozef Forgacz, Marek Pudelko, Jan Kornafel
Bartlomiej Szynglarewicz, Rafal Matkowski, Jozef Forgacz, Marek Pudelko, 2nd Department of Surgical Oncology, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, Wroclaw, Poland
Rafal Matkowski, Jan Kornafel, Department of Gynaecological Oncology, Wroclaw Medical University, Poland
Piotr Kasprzak, Division of Radiology, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, Wroclaw, Poland
Daniel Sydor, Institute of Mathematics, Department of Mathematics and Computer Sciences, University of Wroclaw, Poland
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Bartlomiej Szynglarewicz, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, Plac Hirszfelda 12, 53-413 Wroclaw,Poland. szynglarewicz.b@dco.com.pl
Telephone: +48-71-3689332 Fax: +48-71-3689209
Received: December 28, 2006
Revised: December 20, 2006
Accepted: January 8, 2006
Published online: April 28, 2007
Abstract

AIM: To evaluate the impact of chemoradiation admi-nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter-preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables.

METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log-rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test.

RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P = 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01).

CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.

Keywords: Locally advanced rectal cancer; Anterior resection; Total mesorectal excision; Hysterectomy; Chemoradiation