The outcome of patients with rectal cancer treated by abdominoperineal or anterior resection, with or without preoperative radiotherapy, was assessed to detect any differences attributable to the operative method and interactions between radiotherapy and type of surgery. The study was based on 1292 patients included in two consecutive controlled randomized trials of preoperative radiotherapy in operable rectal carcinoma. The outcome was not related to surgical method. Radiotherapy increased postoperative mortality and complications and reduced local and distant recurrence, but had no effect on overall survival. Effects of radiotherapy were similar irrespective of the type of surgery, except that the increase in postoperative mortality in irradiated patients was greater in those treated with abdominoperineal resection. Sphincter-saving procedures appear to have no adverse effects on outcome of rectal cancer, but the optimum use of radiotherapy is still to be defined.
Most patients with operable rectal cancer have abdominoperineal resection (APR) or anterior resection (AR). For many years APR was the standard procedure for mid and low rectal cancers. The development of stapling instruments has facilitated anastomosis at low levels, with preservation of the anal sphincter. Several studies have compared APR and AR in terms of morbidity, local recurrence rate and survival; most have shown no significant differences between the two methods. However, there has been no randomized trial, and most studies have been retrospective with small numbers of patients1-*.
To reduce local recurrence rate and improve survival after surgery, different adjuvant treatments have been evaluated. Preoperative and postoperative irradiation, alone and in combination with chemotherapy, have been shown to improve local contr01~-~.
This study analysed postoperative mortality, complications, recurrence rate and survival in patients with rectal cancer after APR and AR, with or without preoperative radiotherapy. The aim was to detect differences attributable to operative method and to assess whether the effects of radiotherapy varied with the surgical procedure. The study is based on data from two consecutive prospective controlled randomized trials of adjuvant preoperative radiotherapy, initiated by the Stockholm Rectal Cancer Study Group.