Preoperative radiation therapy and sphincter preservation by the combined abdominotranssacral technique for selected rectal cancers.

In an attempt to reduce the incidence of local recurrence and maintain normal sphincteric function in selected patients treated for rectal cancer, a clinical experience using full dose preoperative radiation therapy and a combined abdominotranssacral technique was begun in 1976. The first 24 of 55 patients treated have now been followed for 20 to 84 months, the median follow-up period being 39 months; sufficient data related to their clinical courses are available for analysis. Cancers were selected on the basis of unfavorability and location in the rectum (3- and 7-cm levels). Clinical staging of the disease was accurate and allowed selection and treatment of only those cancers considered unfavorable (stages B2 and C), thereby avoiding unnecessary radiation of more favorable tumors. One anastomotic disruption required reconstruction, but perioperative complications were otherwise unremarkable. Local recurrence in this group of highly unfavorable cancers has not been observed. Normal and sphincteric function has been preserved in each instance. Preliminary results indicate that full dose preoperative radiation therapy for selected unfavorable and low level cancers permits safe and effective sphincter preservation surgery by the combined abdominotranssacral technique. When proper precautionary measures are observed, surgery can be conducted with the expectation of normal continence and significant reduction in local recurrence.