Document Detail

Intraoperative radiotherapy for oncological and function-preserving surgery in patients with advanced lower rectal cancer.
MedLine Citation:
PMID:  18172677     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pelvic autonomic nerve preservation (PANP) with lateral lymph node dissection (LLND) has been introduced in rectal cancer surgery in Japan; however, its indication has not been standardized yet. MATERIALS AND METHODS: Forty-four patients with advanced lower rectal cancer were randomized to either the standard treatment group (control group) or the intraoperative radiotherapy (IORT) group. All patients underwent potentially curative resection of the rectum with total mesorectal excision. The control group underwent bilateral LLND and limited PANP. The IORT group underwent bilateral LLND, complete PANP, and IORT. Patients allocated to the IORT group received IORT to the bilateral preserved pelvic nerve plexuses. Patients' clinicopathologic parameters, postoperative complications, voiding function, and prognosis were compared between the two groups. RESULTS: Among 44 patients enrolled, three patients were excluded from the analysis, resulting in 19 patients in the IORT group and 22 patients in the control group. Patients' demographic and pathological parameters and postoperative complications were well balanced between the two groups. Oncological outcomes including overall and disease-free survival were also similar. Local recurrence was observed in one patient in each group. Among the 34 patients not complicated with intrapelvic abscess, the mean duration of urinary catheter indwelling was 8 days in the IORT group and 13 days in the control group (p = 0.055). In the long term, medication for urination was necessitated in four patients in the control group, whereas in none in the IORT group (p = 0.059). DISCUSSIONS: Oncological outcomes in the IORT group are equal to those in the control group, and voiding functions in the IORT group are superior to those in the control group. These results suggest that IORT may be useful to expand the indication of complete PANP with LLND for advanced lower rectal cancer.
Tadahiko Masaki; Makoto Takayama; Hiroyoshi Matsuoka; Nobutsugu Abe; Hisayo Ueki; Masanori Sugiyama; Ayako Tonari; Junko Kusuda; Shinsaku Mizumoto; Yutaka Atomi
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-01-03
Journal Detail:
Title:  Langenbeck's archives of surgery / Deutsche Gesellschaft f?r Chirurgie     Volume:  393     ISSN:  1435-2451     ISO Abbreviation:  Langenbecks Arch Surg     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-11     Completed Date:  2009-05-11     Revised Date:  2010-03-29    
Medline Journal Info:
Nlm Unique ID:  9808285     Medline TA:  Langenbecks Arch Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  173-80     Citation Subset:  IM    
Department of Surgery, Kyorin University, Tokyo, Japan.
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MeSH Terms
Autonomic Nervous System / radiation effects,  surgery*
Combined Modality Therapy
Disease-Free Survival
Intraoperative Care*
Kaplan-Meiers Estimate
Lymph Node Excision*
Lymphatic Metastasis / pathology
Middle Aged
Neoplasm Recurrence, Local / etiology,  mortality
Neoplasm Staging
Pelvis / innervation*
Postoperative Complications / etiology,  mortality
Radiotherapy, Adjuvant
Rectal Neoplasms / mortality,  pathology,  radiotherapy*,  surgery*
Rectum / innervation*
Risk Factors
Urinary Catheterization
Urination Disorders / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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