Natural history of patients after abdominal-perineal resection. Implications for radiation therapy

The records of one hundred twenty-three consecutive abdominal perineal resections for rectosigmoid carcinoma were reviewed. One hundred sixteen cases were adenocarcinoma, and seven cases squamous cell carcinoma. Clinical outcome was documented in 111 cases. Overall, 42% survived five years or more. Ultimately 44 of the 123 patients (36%) were proven to have died with tumor and 19 patients (15%) developed clinical manifestations of recurrent pelvic tumor. Five of the 116 patients with adenocarcinoma (4%) died with evidence of pelvic disease only. Second primary tumors were observed in 22 patients (18%). The authors suggest preoperative irradiation to reduce local recurrence and possibly increase disease-free survival. Physicians following these patients should consider them at high risk for cancer in general.