Extended lymphadenectomy and the quality of life in rectal cancer patients.

For a better quality of life in rectal cancer patients, high dose radiotherapy following abdominoperineal resection of the rectum with a pelvic partition is another surgical option replacing extended abdominoperineal resection. In addition to pelvic partition with polyglycolic acid mesh, the tissue expander was inserted into the pelvic cavity to support the intestine upward and the bladder forward. The mean total radiation dosage was 5040 cGy. Between 1989 and 1991, 10 patients were treated according to this method. Out of 10 patients 9 were free of recurrence, and only one had hepatic metastasis. In addition, postoperatively, the average residual urine by this method was 39.1 ml and was statistically different compared to a figure of 200 ml in conventional abdominoperineal resections (p < 0.001, "t"-test). In order to individualize the operative procedures among a variety of surgical options, the molecular biological technique was utilized. In p53 stain analysis of 114 colorectal cancer patients, patients with p53 positive staining reached a higher stage than those with p53 negative staining (p < 0.05, chi 2 analysis). Therefore, we surmised that the positivity of the p53 stain could be one of the factors gauged as an indication of postoperative high-dose radiation. In conclusion, high-dose postoperative radiotherapy was thought to be one of the treatment modalities to improve the survival and quality of life of advanced rectal cancer in selected cases.