P-0290 Sphincter Saving Surgeries For low Rectal Cancer After Neoadjuvant Chemoradiation

Abstract

ABSTRACT Introduction Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The gold standard treatment of primary rectal cancer is curative surgical resection; however, a fine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. In this study we assess different surgical techniques after chemoradiation to preserve anal sphincter Methods Forty nine patients (49) patients with low rectal carcinoma were included in a prospective study, between Jan. 2007 and Jan. 2011. Preoperative chemo radiation was administrated to all patients and subjected different techniques of sphincter saving surgery. Stage IV disease at diagnosis were excluded from study. Results Forty nine patients (49) patients were included in the study. 27 (55%) patients were male and 22 (45%) were female, the age range from 23 years to 70 years with the mean age 38 years. The main presenting symptoms were bleeding per rectum and Tenesmus. Stage I 4 patients (8.1%), stage II 15patients (30.6%), Stage III 30 patients (61.2. Complete clinical and pathological response in 3 patients (6%), complete clinical response in 11 patients (22%), partial response in 27 patients (55%), no significant response in 8 patients (16%). low anterior resection (LAR) in 22 patients (44.9%), Hartman's procedure in 4 patients (8.1%), coloanal pull through ( COP) was done in 19 patients (38.9%) and perineal colostomy was done in 4 patients(8.1). For patients with coloanal pull-through technique complete dehiscent and retraction in one case, major leakage in one case, stenosis in 4 cases. Conclusion There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage due to lack of awareness. Neoadjuvant chemo-radiation is an excellent tool in sphincter saving surgery. Coloanal pull-through operation is new technique for very low rectal cancer with good oncological safety and functional outcome.