Multidisciplinary treatment for locally advanced lower rectal cancer. A comparative study between preoperative chemoradiation and extended pelvic lymphadenectomy

Between 1985 and 2002, patients with T3-4 lower rectal cancer routinely underwent extended surgery with pelvic lymphadenectomy. Between 2002 and 2010, such patients underwent preoperative chemoradiation (CRT) followed by total mesorectal excison (TME) without routine pelvic lymphadenectomy. Oncological outcomes were compared between 121 and 270 patients undergoing CRT and extended surgery in each period, respectively. CRT showed downstaging of TNM stage and more sphincter preserving operation than extended surgery. Although distant metastasis was not decreased, local recurrence was decreased and disease free survival was marginally better in CRT. In conclusion, CRT achieved favorable outcomes without routine pelvic lymphadenectomy compared with extended surgery. (author)