Spincter preservation after selective chemoradiotherapy of rectal cancer : Interim results of the OCUM study

Baral J, Schon MR, Ruppert R, Ptok H, Strassburg J, Brosi P, Kreis ME, Lewin A, Sauer J, Sawicki S, Schiffmann L, Winde G, Junginger T, Merkel S, Hermanek P (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Chirurg Springer Verlag (Germany)

Book Volume: 86

Pages Range: 1138-44

Journal Issue: 12

DOI: 10.1007/s00104-015-0083-z

Abstract

In a prospective multicenter observational study (OCUM) neoadjuvant chemoradiotherapy (nRCT) was selectively administered depending on the risk of local recurrence and based on the distance between tumor and mesorectal fascia in pretherapeutic high-resolution magnetic resonance imaging (MRI).Frequency and quality of abdominoperineal excision (APE) and sphincter preserving operations.Of 642 patients treated in 13 hospitals 389 received surgery alone and 253 nRCT followed by surgery. By univariate and multivariate analysis risk factors for APE were determined. Quality parameters were the quality grade of mesorectal excision, the pathohistological involvement of the circumferential resection margin and intraoperative local dissemination of tumor cells.In 12.8 % of the patients APE was performed. Independent risk factors for APE were tumor location in the lower third of the rectum and the individual hospitals, where APE varied between 0 and 32 %. This variation was chiefly caused by the different case mix. Hospitals with a high APE rate (> 30 %) treated significantly more patients with very low lying carcinomas (< 3 cm above the anal verge) and more advanced tumors. The median height of the tumor in cases of APE was nearly equal in all participating hospitals. Independent on the number of cases the quality of rectal surgery was high. Within the patient groups of primary surgery and nRCT the oncological quality parameter did not significantly differ between sphincter preservation and APE. As far as sphincter preservation is concerned the results justify a selective application of nRCT in patients with rectal carcinoma. The long-term results still have to be awaited.

Authors with CRIS profile

Susanne Merkel Department of Surgery

Involved external institutions

Universitätsmedizin der Johannes Gutenberg-Universität Mainz DE Germany (DE) Klinikum Herford DE Germany (DE) Evangelisches Krankenhaus Lippstadt DE Germany (DE) Franziskus Hospital Bielefeld DE Germany (DE) Klinikum Arnsberg DE Germany (DE) Sana Klinikum Lichtenberg DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Kantonsspital Baselland CH Switzerland (CH) Vivantes - Netzwerk für Gesundheit GmbH DE Germany (DE) Carl-Thiem-Klinikum DE Germany (DE) Städtisches Klinikum München DE Germany (DE) Städtisches Klinikum Karlsruhe DE Germany (DE)

How to cite

APA:

Baral, J., Schon, M.R., Ruppert, R., Ptok, H., Strassburg, J., Brosi, P.,... Hermanek, P. (2015). Spincter preservation after selective chemoradiotherapy of rectal cancer : Interim results of the OCUM study. Chirurg, 86(12), 1138-44. https://doi.org/10.1007/s00104-015-0083-z

MLA:

Baral, J., et al. "Spincter preservation after selective chemoradiotherapy of rectal cancer : Interim results of the OCUM study." Chirurg 86.12 (2015): 1138-44.

BibTeX: Download