Local recurrence of rectal adenocarcinoma following preoperative radiation therapy and surgery

An important therapeutic endpoint of the surgical treatment of rectal adenocarcinoma is to obtain local control. In an attempt to enhance this goal, we started a regimen of treatment consisting of preoperative radiation therapy (PRT), 45 Gy in 5 weeks, followed by surgery 4-6 weeks after termination of the PRT. Depending on the local characteristics of the tumor, either an abdominoperineal resection (APR), a posterior pelvic exenteration (PPE), and a total pelvic exenteration (TPE) were performed. All patients found with distant metastasis were excluded from this study. There were 66 patients: 40 males and 26 females. Fifty six underwent an APR, six a PPE, and four a TPE. Their median age was 56 years. Major complications were intraoperative bleeding (15%); perineal wound infection (21%); abdominal wound infection (9%). Five patients (7.5%) died within 30 days of surgery; two after APR, two after PPE and one after TPE. Median follow-up is 60 months. The overall local recurrence rate is 9.8%. Recurrences related to the Astler-Coller modification of Dukes' stage were 0/21 in A or B1, but 6/40 (15%) when the stages were B2, B3, C1, C2 and C3. In conclusion, we found this treatment approach effective in obtaining local control of the rectal adenocarcinoma and comparable to the results of other series. However, it was associated with significant morbidity and mortality.