Treatment of Rectal Carcinoma

To the Editor.—Odou and O'Connell¹ in their article in the October 1986 issue of the Archives, present interesting data regarding the effect of surgical technique on local recurrence of rectal carcinoma. In their comments, they indicate that "there are several factors that influence pelvic recurrence of rectal carcinoma, including distance of the primary rectal carcinoma from the anal verge, Dukes' staging, histologic grade, and distal margins of resection." They omit mentioning the important additional factor of adjuvant treatment in the form of radiation therapy and chemotherapy, which, in a recent study by the Gastrointestinal Tumor Study Group,^2,3 has been shown to have a significant effect on local recurrence and survival. Patients treated with surgery alone were compared with patients treated with surgery and chemotherapy, radiation therapy, or a combination of irradiation and chemotherapy postoperatively. Surgery consisted of either low anterior or abdominoperineal resection. The surgical technique was