[The place of surgery in the treatment of locally advanced rectal cancer].

We considered as local advanced rectal cancer (LARC) tumours invading the serosa or adherent to neighbouring organs, tumoral fistulas, histopathologically proved invasion of regional lymph nodes, peritoneal carcinomatosis with or without neoplastic ascites. Out of 146 rectal cancers submitted to surgery between 1984-1996, 47 had LARC (19 man and 28 women aged of 19 to 88 years) developed in the inferior 2/3 of rectum. We performed in these cases 11 Miles operations, 12 posterior pelvectomies, 3 Dixon resections, 16 colostomies and 5 exploratory laparotomies. To these were associated 4 partial cystectomies, 4 anexectomies, 4 partial enterectomies and 2 excisions of hepatic metastasis. In 27 patients adjuvant or neoadjuvant therapy was associated. We registered 3 deaths, 6 parietal infections and 1 stercoral fistula. Postoperative survival was 3-6 months for 12 patients, 6-12 months for 13 patients, 1-2 years for 6 patients. After the complex treatment 6 patients were alive at 5 years. Surgery is the essential therapeutic act of LARC. Chemo/radiotherapy association increases the survival, but not significantly.