RECTAL-CARCINOMA - ARE WE MAKING A DIFFERENCE

Evaluation of preliminary results at our institution revealed an impro vement in survival of patients treated for rectal cancer from 1950-198 8. A study was conducted to analyze responsible factors. A total of 33 5 patients with accurate staging and follow up for at least 5 years or until death were reviewed retrospectively. Of the 335 patients, 295 ( 88%) were treated by surgical resection, abdominal perineal resection (APR) (n = 179), and anterior resections (n = 105), the most common pr ocedures. Operative mortality for patients with curable disease (n = 1 88) was 18 per cent (n = 34), which has significantly decreased from 2 4 per cent (n = 28) (1950-1969) to 8 per cent (n = 6) (1970-1988), (P < 0.01). Operative mortality for APR and anterior resection was 22 per cent (n = 29) and 8 per cent (n = 5), respectively. Mortality for APR decreased from 28 per cent (1950-1969) to 10 per cent (1970-1988) (P < 0.02) accounting for most of the improvement. Of the 335 patients, 1 42 (42%) presented with stage IV disease, which decreased from 54 per cent (n = 47) (1950s) to 22 per cent (n = 10) (1980s), P < 0.01. The o verall 5-year survival was 19 per cent (n = 64), with a corresponding increase per decade from 13 per cent (1950s) to 43 per cent (1980s), ( P < 0.001). Of the remaining 188 patients, 41 had involved surgical ma rgins and decreased 5-year survival of 8 per cent when compared to pat ients with clear surgical margins (37%) P < 0.01). Multifactor analysi s revealed that stage of disease at presentation, involved surgical ma rgins, and operative mortality were significant independent variables. Earlier stage at presentation and improved operative management incre ased the survival of patients with rectal cancer at our institution.