Clinical Research Papers:
Preoperative chemoradiotherapy creates an opportunity to perform sphincter preserving resection for low-lying locally advanced rectal cancer based on an oncologic outcome study
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Jun-Zhong Lin1,*, Jian-Hong Peng1,*, Aiham Qdaisat2,*, Zhen-Hai Lu1, Xiao-Jun Wu1, Gong Chen1, Pei-Rong Ding1, Li-Ren Li1, Yuan-Hong Gao3, Zhi-Fan Zeng3, De-Sen Wan1, Zhi-Zhong Pan1
1Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, P.R. China
2Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
3Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, P.R. China
*These authors have contributed equally to this work
Zhi-Zhong Pan, email: email@example.com
Keywords: preoperative chemoradiotherapy, sphincter preserving resection, rectal cancer, oncologic outcome
Received: February 21, 2016 Accepted: June 02, 2016 Published: June 27, 2016
Low-lying locally advanced rectal cancer (LARC) after preoperative chemoradiotherapy (CRT) can be surgically removed by either abdominperineal resection (APR) or sphincter preserving resection (SPR). This retrospective cohort study of 251 consecutive patients with low lying LARC who underwent CRT followed by radical surgery in a single institute, between March 2003 and November 2012, aimed to compare the oncological benefits between the two groups. 3-year disease free survival (DFS), overall survival (OS), cumulative incidence of recurrence and postoperative complications were compared between the two approaches. With median follow-up of 48.6 months, SPR group had higher 3-year DFS rate (86.4% vs 73.6%, P=0.023) and lower incidence of distant recurrence (12.0% vs 23.7%, P=0.026). The postoperative complications, incidence of local recurrence and the 3-year OS were comparable between the two groups. Pathologic T and N stage were the independent predictors for 3-year DFS (P=0.020 and P<0.001). In conclusion, our study suggest that low-lying LARC patients with a significant response to preoperative CRT can benefit from the advantage of SPR in preserving the anal sphincter function without compromising their oncologic outcome.
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