OBJECTIVETo compare the long-term efficiency between preoperative radiotherapy or radiochemotherapy followed by lower-anterior resection and abdominoperineal resection (APR) for lower and locally advanced rectal cancer.

METHODSFrom January 1983 to December 2000, 157 consecutive patients suffering from lower rectal cancer were enrolled in the study, which included 69 cases of clinical stage II and 88 cases of stage III respectively. All patients were divided in to three groups. Patients in group A (n=52) received preoperative radiotherapy with a total dose of 35-45 Gy within 4-5 weeks plus preoperative chemotherapy with 5-fluorouracil (5- FU) followed by lower-anterior resection; patients in group B (n=51) received radiotherapy followed by lower-anterior resection; patients in group C (n=54) received APR only. Clinical data of all patients were reviewed retrospectively.

RESULTSThe follow-up rate was 91.7%. The 5- year survival rate was higher in group A (71.1%) than those in group B (47.1%) and group C (42.6%)(P< 0.05). The tumor- free survival rate was higher in group A (61.5%) than those in group B (37.3%) and group C (35.2%)(P< 0.05). The local recurrence rate was 13.5%, 15.7% and 11.1% in group A, B and C respectively, there was no significant difference in recurrence rate among three groups (P> 0.05). The distant metastasis rate was lower in group A (23.1%) than those in group B (49.0%) and group C (46.3%)(P< 0.05), but there was no significant difference in distant metastasis rate between group B and group C.

CONCLUSIONSThe combined preoperative radiochemotherapy followed by lower-anterior resection can improve the 5-year survival rate and tumor-free survival rate, and decrease distal metastasis rate.