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Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: abdominoperineal resection versus sphincter-preserving procedure

 Jin Soo Kim  ;  Hyuk Hur  ;  Nam Kyu Kim  ;  Young Wan Kim  ;  Sun Yeon Cho  ;  Jeong Yeon Kim  ;  Byung Soh Min  ;  Joong Bae Ahn  ;  Ki Chang Keum  ;  Hoguen Kim  ;  Seung Kook Sohn  ;  Chang Hwan Cho 
 ANNALS OF SURGICAL ONCOLOGY, Vol.16(5) : 1266-1273, 2009 
Journal Title
Issue Date
Chemotherapy, Adjuvant ; Colectomy/methods* ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy* ; Retrospective Studies ; Treatment Outcome
Anal Sphincter ; Anterior Resection ; Total Mesorectal Excision ; Oncologic Outcome ; Circumferential Resection Margin
BACKGROUND: Over the past several years, preoperative chemoradiotherapy (CRT) has contributed remarkably to make more sphincter-preserving procedure (SPP) possible for lower rectal cancer. The aim of this study was to compare the outcomes between abdominoperineal resection (APR) and SPP after preoperative CRT in patients with locally advanced lower rectal cancer.

METHODS: A retrospective investigation was conducted with a total of 122 patients who underwent radical surgery combined with preoperative CRT for locally advanced lower rectal cancer. Of these, 50 patients underwent APR and 72 received SPP. Surgery was performed 6-8 weeks after completion of preoperative CRT. Oncologic outcomes were compared between the two groups, and the clinicopathologic factors affecting the treatment outcomes were evaluated.

RESULTS: Circumferential resection margin (CRM) involvement (P = 0.037) and postoperative complication rate (P = 0.032) were significantly different between APR and SPP. Patients who underwent APR had a higher 5-year local recurrence (22.0% vs. 11.5%, P = 0.028) and lower 5-year cancer-specific survival (52.9% vs. 71.1%, P = 0.03) rate than those who underwent SPP. Pathologic N stage was the most critical predictor for local recurrence and survival.

CONCLUSIONS: Our study shows that APR following preoperative CRT exhibited more adverse oncologic outcomes compared with SPP. This result may be due to higher rates of CRM involvement in APR even with preoperative CRT. We suggest that sharp perineal dissection and wider cylindrical excision at the level of the anorectal junction are required to avoid CRM involvement and improve oncologic outcomes in patients who undergo APR following preoperative CRT.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Young Wan(김영완)
Kim, Jeong Yeon(김정연)
Kim, Hogeun(김호근)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Sohn, Seung Kook(손승국)
Ahn, Joong Bae(안중배) ORCID logo https://orcid.org/0000-0001-6787-1503
Cho, Sun Yeon(조선연)
Cho, Chang Hwan(조장환)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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