PREDICTION OF LOCAL RECURRENCE AND SURVIVAL OF CARCINOMA OF THE RECTUM BY SURGICAL AND HISTOPATHOLOGICAL ASSESSMENT OF LOCAL CLEARANCE

The surgeon and histopathologist were asked to assess whether clearanc e of the resected primary rectal tumour was complete or not. The resul ts of each assessment were related to survival and recurrence rates. O f 478 patients entered, full information was available for 396 who wer e followed to death or for at least 5 years. The surgeon and pathologi st agreed on the clearance in 341 of the 396 patients. The 5-year loca l recurrence rate was 15 per cent in the 331 patients with complete lo cal clearance and 62 per cent in those with incomplete clearance. Ther e was disagreement regarding 55 patients (14 per cent) (39 pathologist 'incomplete'/surgeon 'complete'; 16 surgeon 'incomplete'/pathologist 'complete'). Local recurrence occurred later where the pathologist ass essed resection to be incomplete (log rank chi(2) = 11.0, 1 d.f., P = 0.001). Of 321 patients without metastatic disease, the surgeon and pa thologist agreed in 290 that 284 had complete and six incomplete clear ance. The 5-year survival rates were 53 and 0 per cent respectively. T here was disagreement regarding 31 patients (10 per cent) (11 surgeon 'incomplete'/pathologist 'complete'; 20 pathologist 'incomplete'/surge on 'complete'). The 5-year survival rates were 18 and 10 per cent resp ectively (log rank chi(2) = 1.5, 1 d.f., P = 0.2). Surgical and histop athological assessments of local clearance are important in determinin g local recurrence and survival.