LONG-TERM SURVIVAL AFTER CURATIVE RESECTION FOR CARCINOMA OF THE RECTUM

The clinical outcome of 453 patients with histologically confirmed ade nocarcinoma surveyed from 1980 to 1999 was evaluated. Special consider ation was given to the prognostic significance of local recurrence and distant metastases as the significant contributors to postoperative m orbidity and mortality. Of 453 patients, 371 were treated by a curativ e surgical approach. The remaining 82 patients, with extended disease, received palliative treatment. Among those undergoing surgical treatm ent, the local recurrence rate was 11.3 percent; the incidence of dist ant metastases was 16.2 percent, and 2.7 percent of the patients exhib ited combined lesions. The five-year survival rate depended on the ext ent of the primary lesion and lymph node status-it was highest for pat ients with stage I adenocarcinoma (80 percent), a rate significantly b etter (p<0.01) than patients with stage II disease (40 percent), who f ared better (p<0.02) than patients with stage III disease (30 percent) (Union Internatinale Contre le Cancer [International Union Against Ca ncer] classification). Sixty percent of the patients with local recurr ence and almost 70 percent with distant spread showed proof of failure within two years. Of 42 patients with local failure, 12 underwent reo peration without leaving residual tumor (RO-treatment) but exhibited n o improvement in five-year survival compared with those with no second surgical approach. The operative techniques were abdominoperineal res ection (36.9 percent), low anterior resection (58.2 percent) and trans anal resection (4.9 percent). They were without significant influence on long term results. Critical analysis of the data emphasizes the urg ency of adjuvant treatment for patients with poor long term prognosis, as given for stages IIB and III.