{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:39:05Z","timestamp":1773268745526,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,1,6]],"date-time":"2015-01-06T00:00:00Z","timestamp":1420502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,1,6]],"date-time":"2015-01-06T00:00:00Z","timestamp":1420502400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study is to assess oncological outcome after changing operative strategy from abdominoperineal resection (APR) to sphincter preservation (SP) in T3 low rectal carcinomas downstaged by neoadjuvant chemoradiation (nCRT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>This was a prospective observational study performed at academic medical centers. Patients with T3 rectal carcinoma, (&lt;1\u00a0cm from the top of anal sphincter) received long\u2010course neoadjuvant chemoradiation. Decision before chemoradiation was APR in all patients. Patients who had successful downstaging were included in the study. Low anterior resection (LAR) was performed after 8\u201311 weeks from completion of nCRT. Follow\u2010up duration ranged from 4 to 6 years. Salvage surgery was done for local recurrence when possible. The primary endpoint of the study was disease\u2010free survival. Secondary endpoints were morbidity, mortality, continence, and oncologic results of salvage surgery after recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>LAR with colorectal or coloanal anastomosis were done in 9 and 36 patients, respectively. After a mean follow\u2010up of 57\u00a0months (range 48\u201370), local recurrences was reported in 4 patients (8.8 %), one of them had also distant metastasis while 2 patients (4.4 %) had only distant metastasis. Disease\u2010free and overall survival rates were 87 and 89 %, respectively. Three of 4 patients with local recurrence (the fourth had liver metastasis) underwent salvage APR with free safety margins. Follow\u2010up after salvage surgery for 31, 33, and 37\u00a0months revealed no recurrences. Wexner continence score \u22644 was noted in 39 patients; while major incontinence (Wexner score &gt;12) was noted in 2 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For selected patients of T3 low rectal cancer, changing operative strategy from APR to SP after downstaging by nCRT can be done in motivated patients with good sphincter function. Disease\u2010free survival rates and continence are comparable to patients had APR and to previous publications with decision made before nCRT. With strict follow\u2010up, early diagnosis of recurrence and salvage surgery with free resection margins can be achieved.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2930-3","type":"journal-article","created":{"date-parts":[[2015,1,5]],"date-time":"2015-01-05T16:24:12Z","timestamp":1420475052000},"page":"1248-1256","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Changing Operative Strategy from Abdominoperineal Resection to Sphincter Preservation in T3\u00a0Low Rectal Cancer after Downstaging by Neoadjuvant Chemoradiation: A Preliminary Report"],"prefix":"10.1002","volume":"39","author":[{"given":"Khaled M.","family":"Madbouly","sequence":"first","affiliation":[{"name":"Department of Surgery University of Alexandria El Raml Station Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M.","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Alexandria El Raml Station Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,1,6]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.3.257"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2004.10.010"},{"key":"e_1_2_7_4_2","first-page":"1703","article-title":"Preoperative chemoradiation therapy for low rectal cancer. 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