CURATIVE RESECTION FOR STAGE-I RECTAL-CANCER - NATURAL-HISTORY, PROGNOSTIC FACTORS, AND RECURRENCE PATTERNS

Our goal was to evaluate the recurrence patterns and outcomes of a lar ge group of patients with stage I rectal adenocarcinoma treated at a s ingle institution with uniform surgical and pathological techniques. M edical records of 71 patients who had undergone potentially curative s urgery were reviewed to determine clinical and histologically signific ant prognostic factors that could affect survival and recurrence patte rns. The median follow-up for all patients was 81 months. Twenty patie nts had T(1)N(0)M(0) cancers and 51 patients had T(2)N(0)M(0) cancers. The median number of lymph nodes examined per surgical specimen was 3 2. There were no recurrences in the 20 patients with T-1 lesions. All 7 recurrences (10%) occurred in patients with T-2 lesions. Only 2 of t hese recurrences were local. In the T-2 group, the 5- and 10-year dise ase-free survivals were 88% and 83%, respectively. The 5- and 10-year disease-free survival for all state 1 lesions was 91% and 88%, respect ively. The overall recurrence rate of 10% does not justify adjuvant th erapy for stage I rectal adenocarcinoma. Although the subset of patien ts with T(2)N(0)M(0) distal one-third rectal cancers may be at risk fo r recurrence, additional prognostic factors are needed to evaluate the se patients before adjuvant therapy can be recommended.