Changing strategy for rectal cancer is associated with improved outcome

Background: In 1980, surgery for rectal cancer at the Department of Surgery , Uppsala University Hospital was concentrated to a colorectal unit and a m ore systematic use of adjuvant radiotherapy began. In 1985, total mesorecta l excision was introduced. The aim of this study was to determine whether t hese changes had an impact on the overall treatment outcome. Methods: Some 423 consecutive patients with rectal cancer had surgery betwe en 1974 and 1995 and were followed up until 1 January 1998. Outcome analysi s was made according to the following predefined intervals of diagnosis: 19 74-1979, 1980-1984 and 1985-1995. Results: The overall local recurrence rate was 47 per cent in the first int erval, and 13 and 11 per cent during the second and third respectively (P < 0.001). In the third interval, of 119 patients who received preoperative i rradiation and underwent radical resection, only three (3 per cent) had loc ally recurrent rectal cancer. There was improved cancer-specific survival b etween the first and the last intervals of the study (P = 0.03). Conclusion: These data are consistent with the interpretation that the resu lts of treatment can be improved by concentration of surgery to a colorecta l team.