PELVIC RECURRENCE FOLLOWING RESECTION OF RECTAL-CANCER - A MULTIVARIATE PREDICTIVE MODEL

Local recurrence of rectal cancer (LR) after ''curative'' surgery is a major clinical problem, with a low resectability rate and a dismal pr ognosis, Prediction of LR might permit more targeted postoperative sur veillance with earlier diagnosis of recurrent disease and might help i n selecting the patients to be assigned to the most suitable adjuvant treatment protocol, To evaluate if a simple multivariate model could p redict the LR and survival probability in the single case, we retrospe ctively evaluated 118 consecutive patients (63 males, 55 females; mean age 62 +/- 12 years) operated on for rectal cancer and followed up fo r a minimum of 4 years (range 51-111 months), Local recurrence rate wa s 28%, with a 6% of local + distant failure, Age and sex of patients, type of surgery, location of tumour in the rectum, size, morphology an d grading of the tumour were all unrelated to the event under investig ation, At Cox regression, the Dukes' stage and the postoperative radio therapy were the only independent prognostic factors for LR (p < 0.001 ). The multivariate model was able to correctly reclassify the patient s and predict local recurrence in 86.2% of the cases. Prevention of LR by adequate surgery and adjuvant therapy as well as its early detecti on offer the best prospect of improving the results of surgery for rec tal cancer.