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We report the 10\u2010year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ULRC indicated for APR were included (<jats:italic>n<\/jats:italic>\u2009=\u2009207). Randomization was between high\u2010dose radiation (HDR, 45\u2009+\u200918\u2009Gy) and radiochemotherapy (RCT, 45\u2009Gy\u2009+\u20095FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)\/complete (CISR) intersphincteric resection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10\u2010year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%\/14.5%) and 27.6% metastases (32.4%\/27.7%). OS and disease\u2010free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long\u2010term oncologic follow\u2010up validates this attitude.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.26249","type":"journal-article","created":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T19:20:23Z","timestamp":1603567223000},"page":"299-310","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Sphincter\u2010saving surgery for ultra\u2010low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long\u2010term follow\u2010up?"],"prefix":"10.1002","volume":"123","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0415-3269","authenticated-orcid":false,"given":"Philippe","family":"Rouanet","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology Institut r\u00e9gional du Cancer de Montpellier (ICM) \u2013 Val d'Aurelle Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Rivoire","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Centre L\u00e9on Berard Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Gourgou","sequence":"additional","affiliation":[{"name":"Montpellier Cancer Institute, Biometrics Unit Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Lelong","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Institut Paoli Calmettes Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Rullier","sequence":"additional","affiliation":[{"name":"Colorectal d\u00e9partement CHU Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merhdad","family":"Jafari","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Centre Oscar Lambret Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Mineur","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Institut Sainte Catherine Avignon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Pocard","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Gustave Roussy (hopit Mal Lariboisiere APHP) Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Luc","family":"Faucheron","sequence":"additional","affiliation":[{"name":"Colorectal d\u00e9partement CHU Grenoble Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Dravet","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Centre Ren\u00e9 Gauducheau Nantes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Pezet","sequence":"additional","affiliation":[{"name":"Colorectal d\u00e9partement CHU Clermont\u2010Ferrand Clermont\u2010Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Michel","family":"Fabre","sequence":"additional","affiliation":[{"name":"Colorectal d\u00e9partement CHU Montpellier Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Bresler","sequence":"additional","affiliation":[{"name":"Colorectal d\u00e9partement CHU Nancy Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Balosso","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy CHU Grenoble Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Taoum","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Institut r\u00e9gional du Cancer de Montpellier (ICM) \u2013 Val d'Aurelle Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Lemanski","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Institut r\u00e9gional du Cancer de Montpellier (ICM) \u2013 Val d'Aurelle Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,24]]},"reference":[{"issue":"3","key":"e_1_2_8_2_1","first-page":"169","article-title":"Bradshaw lecture, 1978. 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