Recurrence and survival after surgical management of rectal cancer

BACKGROUND: Reported local recurrence rates for rectal cancer are significa ntly reduced using a combination of superior surgical technique, in the for m of total mesorectal excision, and routine radiotherapy. In an attempt to determine the effectiveness of current local management strategies, a revie w of Vancouver island Cancer Centre patients with rectal cancer was perform ed and the overall local recurrence rate was identified. METHODS: We retrospectively reviewed the charts of 272 rectal cancer patien ts from 1988 to 1998, Two hundred and twenty-nine patients met inclusion cr iteria. Analysis of patient factors included age, gender, type of surgery, and adjuvant therapy. Tumors were assessed for level, stage, and grade. Loc al recurrence and distant metastases were also documented. Variables influe ncing local recurrence in this group were identified and disease-free and a ctuarial survival determined. RESULTS: Of 229 patients analyzed, 12.7% (29) had local recurrences. Variab les influencing local recurrence were number of positive lymph nodes, vascu lar invasion, and neural invasion. There was no significant difference in l ocal recurrence between patients having anterior resection and those having abdominoperineal resection. None of the patients who received preoperative radiotherapy had a local recurrence. Actuarial disease-free survival was 8 7% at 5 years. CONCLUSIONS: Limiting local recurrence is one of the most important goals i n the treatment of rectal cancer. It is essential to identify those patient s with "high risk" tumors as identified by endorectal ultrasound or patholo gic features. These patients comprise the group most likely to benefit from a routine mesorectal excision combined with adjuvant radiotherapy. Am J Su rg. 1999;177:392-395. (C) 1999 by Excerpta Medica, Inc.