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February 1990

A Phase I Trial of Preoperative Radiation, Proctectomy, and Endoanal Reconstruction

Author Affiliations

From the Colorectal Service, Department of Surgery (Dr Cohen), and the Department of Radiation Oncology (Dr Minsky), Memorial Sloan-Kettering Cancer Center, New York, NY.

Arch Surg. 1990;125(2):247-251. doi:10.1001/archsurg.1990.01410140125020

• The purpose of this study was to explore the feasibility of sphincter preservation in abdominoperineal resection candidates by combining high-dose preoperative radiation therapy with restorative proctectomy through an endoanal anastomosis. Radiation to the pelvis was given using a three- or four-field technique to 4680 cGy (180 cGy/d) with portals from the top of S1 to 2 cm below the anus. The tumor bed received an additional 360-cGy boost. Four to 6 weeks after radiation therapy was completed, the patients underwent radical surgery. Phase I results for 14 patients are presented. All surgical specimens had negative distal and lateral margins. Surgical complications included one small-bowel obstruction requiring reoperation at 3 weeks, one pulmonary embolism, and one partial disruption (30% of the circumference) of the anastomosis. Bowel control and function were excellent in 8 and good in 4 patients. Function was not yet assessable in the remaining 2 patients.

(Arch Surg. 1990;125:247-251)