Surgical treatment of patients with rectal cancer following long-term neoadjuvant radio-chemotherapy

Aim: We are presenting the early observations of surgical interventions performed on locally advanced stage rectal cancer patients after long-term neoadjuvant radio-chemotherapy. Our objective was to achieve down-staging as a result of oncological treatment in case of these patients in order to make the rectal cancer locally operable or to perform sphincter preserving resections.

Patients and methods: On the Department of Surgery in cooperation with the Department of Oncology 10 locally advanced stage rectal cancer patients were treated between 1st August 2005 and 31st January 2006. The average age of the patients was 66 years, involving 4 male and 6 female patients. The preoperative staging proved T3–4N1–2 stages. Considering the local stage of the rectal process or its proximity to anal sphincter, neoadjuvant treatment was applied (radiotherapy 25 fractions all together 45 Gy, furthermore 350mg/m2/day 5-FU and 20mg/m2/day Leukovorin chemotherapy for 5–5 days on the first and the last week).

Results: The oncological treatment is still in process in 2 cases. In case of 8 patients operations were performed 6–8 weeks after the oncological treatment. In 6 cases sphincter preserving resections, in 1 case abdominoperineal resection and in 1 case Hartmann's procedure were done. The pathological examination proved almost complete remission (pR1N0) compared to the preoperative staging in 1 case, partial remission (pT2–3N0) in 4 cases, while in 3 cases remission (pT3–4N1–2) was not observed. There were no postoperative complications and mortality.

Conclusions: As a result of down-staging after long-term neoadjuvant radio-chemotherapy, the locally advanced stage rectal cancer can achieve a surgically operable stage, or enable to perform sphincter preserving resection, which ensure a better quality of life for patients.