Preoperative staging of rectal cancer allows selection of patients for preoperative radiotherapy

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Abstract
Background: Variability in rates of local recurrence following resection of rectal cancer has led to the suggestion that all patients should undergo preoperative radiotherapy. This centre employs a selective policy of radiotherapy only in patients with evidence of advanced local disease determined by preoperative staging. Methods: A retrospective review was carried out of 114 consecutive patients with rectal cancer. Patients were divided before operation into palliative and curative groups based on preoperative staging. Only patients in the palliative group were offered preoperative radiotherapy. Total mesorectal excision (TME) was performed for all tumours of the middle or lower rectum. Results: The perioperative mortality rate was 0·9 per cent and anastomotic dehiscence occurred in 2·8 per cent. Local recurrence developed in 4 per cent of patients in the ‘curative’ group and in seven of 15 of those assigned to the palliative group before operation (P < 0·01). Positive lateral resection margins were significantly associated with a risk of subsequent recurrence (ten of 13 versus three (3 per cent) of 93; P < 0·001). Conclusion: Preoperative adjuvant radiotherapy can be omitted reasonably in patients in whom there is no evidence of locally advanced disease, provided that adequate surgery, incorporating TME for low tumours, is performed.