Role of Combined Neoadjuvant Radiochemotherapy with TME in Treatment of Locally Advanced Mid-Distal Rectal Cancer

Objective To explore the value and feasibility of combined neoadjuvant radiochemotherapy with TME in the treatment of locally advanced mid-distal rectal cancer. Methods One hundred and eleven patients with locally advanced mid-distal rectal cancer (T3～4N0～2M0) underwent preoperative radiochemotherapy with a dose of 50 Gy.Chemotherapy regimens were oxaliplatin combined capecitabine (combination group) and the single agent alone without oxaliplatin (single drug group).One hundred and five patients received radical(R0) TME operations within 2～10 weeks after radiochemotherapy and the efficacy of the radiochemotherapy could be evaluated according to the postoperative pathological results. Results Radical TME were carried out on 105 patients with clear margin.Sphincter-sparing surgery was performed in 42 (37.8%) patients.Radical (R0) TME operations were performed in 15 (83.3%) out of the 18 T4 patient,staged by the MRI and CT,after radiochemotherapy.There were no severe complications during the treatment of neoadjuvant radiochemotherapy or operation.There were 15 cases (14.3%) with complete tumor regression,26 cases (24.8%) with maximal tumor regression,40 cases (38.1%) with moderate tumor regression and 24 cases (22.8%) with minimal tumor regression. Conclusion It is concluded that the combined neoadjuvant radiochemotherapy with TME leads to increased sphincter-sparing and radical(R0) surgery with no addition of complications,which is a feasible treatment on locally advanced mid-distal rectal cancer.It should be a preferred regimen for the locally advanced mid-distal rectal cancer.