Sphincter Saving Surgery in Locally Advanced Low Rectal Cancer after Neoadjuvant Chemoradiotherapy

Abstract
Aim: To evaluate the feasibility of sphincter saving surgery in locally advanced low rectal cancer after neoadjuvant concomitant chemoradiotherapy (CCRT) by assessing the effect of CCRT on downstaging of primary tumor, hence sphincter preservation rate and outcome.
Patients and Methods: Patients presenting to the National Cancer Institute-Cairo University from May 2014 to October 2014; with locally advanced low (3-6m from the anal verge) rectal cancer received long-course CCRT and the response was evaluated, then they were subjected to APR or sphincter saving surgery.
Results: The study started by 60 patients; 33/60 (55%) underwent APR, 25/60 (41.7%) underwent sphincter saving surgery and 2/60 patients (3.3%) lost follow-up.
The clinical response was assessed by the status of the distance from the anal verge: It increasedin 23/60 patients (38.33%), stationary in 17/60 patients (28.33%) and decrea-sedin 20/60 patients. The radiological response showed: downstaging occurred in 27/60 (45%). Pathological response revealed: Down-staging in 28/58 patients (48.3%).
Negative distal margin was obtained in all patients had sphincter saving surgery with one case only had positive radial margin.
Conclusion: Sphincter saving surgery is an oncologically safe alternative to the standard APR in low rectal cancer, with the added benefit of avoiding a permenant stoma. The use of preoperative concomitant chemoradiotherapy (CCRT) enhances the rate of sphincter saving surgery by downsizing and down-staging of the tumors.