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Alfred M. Cohen, MD; Bruce D. Minsky, MD

Arch Surg. 1990;125(2):247-251.

Abstract
• 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)

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.

Footnotes
Accepted for publication September 18, 1989.

Read before the annual meeting of the Society of Surgical Oncology, San Francisco, Calif, May 23, 1989.

Reprint requests to Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (Dr Cohen).

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