Presented at the 53^rd Annual Cancer Symposium in New Orleans, Louisiana

SPHINCTER PRESERVATION OPTIONS UTILIZING HIGH DOSE PREOPERATIVE IRRADIATION FOR DISTAL RECTAL CANCER IN THE ELDERLY

J. MARKS, MD, C. BARTOS, MD, G MARKS, MD, M. MOHIUDDIN, MD

The preservation of normal function in the management of distal rectal cancer remains as dominant an issue in the elderly as it does in younger patients.  Out of a group of 313 patients we analyzed 78 patients with cancer in the distal ½ of the rectum whose age ranged from 70 to 88 y.o.; 70-74 n=38, 75-79 n=25, >80 n=15.  There were 47 men.  ASA classification were available on 60% of the patients:  11% class I, 46% Class II, AND 43% class III.  Patients were treated with preoperative irradiation (4500-7000Gy) and surgery was performed 4-8 weeks later.  Resection was accomplished by local excision in 23 patients and radical resection with temporary diverting stoma in  55 patients.  Perioperative mortality was 1% (MI).  There were two episodes of perioperative atrial fibrillation and no significant pulmonary morbidity.  There were no significant radiation related injuries.  Six patients did not have their stoma closed because of anastomotic or medical problems.  Sphincter function was good to excellent by Park’s Criteria in 89.5%.  Average follow-up was 47.2 mos (2-164 mos.) Overall LR was 5.1%, 13% in the local excision group and 2.0% in the radically resected group (p<0.05).  DM developed in 15% of the patients (12/78).  KM 5YAS was 72%.  With proper patient selection mid and distal rectal cancers can be managed with preoperative irradiation and surgery to preserve anal sphincter function in patients 70 years and older.  Radical resections, when medically feasible, in this group have a lower local recurrence rate.

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