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08-11-2011 | Article

APR and AR without radiotherapy have similar local recurrence rates


Free abstract

MedWire News: Recurrence rates after abdominoperineal resection (APR) for rectal cancer are similar to those after anterior resection (AR), according to research into outcomes of surgery without radiotherapy.

David Larson and colleagues from the Mayo Clinic College of Medicine in Rochester, Minnesota, USA, conducted a retrospective review of 655 patients with rectal cancer treated using surgery without radiotherapy.

"Abdominoperineal resection has come under recent scrutiny," they write. "Indeed, data documenting positive circumferential margins and high rates of local recurrence have prompted a call for change in APR technique."

The researchers say they aimed to "help inform these debates," by examining recurrence and survival after primary surgery for rectal cancer at the Mayo Clinic.

Of the rectal cancer patients studied, 409 underwent AR and 246 received APR. The overall 5-year rate of local recurrence was 4.3%, with recurrence rates nonsignificantly lower following AR compared with APR (3.6 vs 5.5%).

Disease-free and cancer-free survival of the total patient cohort were 90.0% and 91.5%, respectively. Survival rates were no poorer in the patients who underwent APR compared with AR.

The study, published in the British Journal of Surgery, considered the patients' surgery outcomes in terms of disease stage: 397 had stage I disease, 125 stage II, and 133 stage III. There was no significant difference in stage-specific survival after AR and APR.

"The finding of no differences, stage for stage, in local recurrence between APR and sphincter-sparing surgery is most likely commitment to techniques that ensure negative circumferential resection margins and distal margins," the researchers write.

They add that "the overall local recurrence rate for patients with stage III disease without the use of neoadjuvant or adjuvant radiotherapy was 5%, suggesting that some stage III disease can be well controlled with surgery alone."

The patients studied did not receive chemoradiotherapy for various reasons, including comorbidities, patient choice, and delay due to complication, and allowed the researchers to compare AR and APR without radiation therapy as a confounding factor.

The results suggest that, provided surgery is well-performed and standardized, in some cases "radiation therapy may not confer much additional benefit."

In response to the dispute over APR, they conclude: "The commitment to a standardized wide resection should be the current approach to APR rather than prone positioning, routine coccygectomy and flap closure of resulting wide perineal wounds."

By Chloe McIvor