To evaluate the effect and security of neoadjuvant chemoradiotherapy in combination with total mesorectal excision (TME) in treatment of advanced middle and lower rectal carcinoma.

Fifty-six patients of advanced middle and lower rectal carcinoma were retrospectively recruited and divided into observation group and control group from January 2010 to January 2011, with 28 cases in each group. Neoadjuvant chemoradiotherapy combined with TME were given to observation group and TME alone was performed in control group. TNM stage, tumor marker levels and adverse reactions were recorded before and after neoadjuvant chemoradiation. The R0 radical resection rate, sphincter preservation rate, local recurrence rate and metastasis rate were compared between the two groups.

After neoadjuvant chemoradiation, the TNM stage in observation group improved significantly, the difference statistically significant compared with that before treatment (μ=1.960, P=0.000). In the meantime, the levels of CEA, CA19-9, CA242 and CA724 in observation group significantly decreased, and the difference was statistically significant compared with that before treatment (t=9.276, 8.716, 9.420, 6.512, all P<0.01). The R0 radical resection rate and sphincter preservation rate of observation group were significantly higher than control group (89.28% vs 60.71%, 75.00% vs 32.14%, χ²=6.095, 10.338, P=0.014, 0.001). After a 1-year follow-up, local recurrence rate and metastasis rate of observation group were significantly lower than those of control group, with statistically significant differences (7.14% vs 28.57%, 21.43% vs 46.43%, χ²=4.383, 3.903, P=0.036, 0.048).

Neoadjuvant chemoradiotherapy combined with TME can obtain improved curative effect in treatment of advanced middle and lower rectal carcinoma, and it is worthy of clinical application.