T3N0 rectal cancer: Results following sharp mesorectal excision and no adjuvant therapy

Adjuvant chemoradiation therapy following resection of T3N0 rectal cancer i s recommended in order to reduce the incidence of local recurrence and impr ove survival. However, recent experience with rectal cancer resection utili zing sharp dissection and total mesorectal excision has resulted in a reduc tion in local recurrence rates to as low as 5% without adjuvant treatment. The purpose of this study was to determine if rectal cancer resection utili zing sharp mesorectal excision alone is adequate treatment for local contro l of T3N0 rectal cancer. Between July 1986 and December 1993, 95 patients w ith T3N0M0 rectal cancer underwent resection with sharp mesorectal excision and did not receive any adjuvant therapy. Various prognostic factors were analyzed for their association with local recurrence and survival. Seventy- nine patients had a low anterior resection, 10 of whom had a coloanal anast omosis, and 16 had an abdominoperineal resection. The median follow-up was 53.3 months. Six patients had local recurrence, 12 had distant recurrence, and three had local and distant recurrences. The overall local recurrence r ate was 9% crude and 12% 5-year actuarial. The overall crude recurrence rat e was 22%. The 5-year disease-specific survival rate was 86.6% with an over all survival of 75%. Postoperative complications occurred in 18 patients (1 9%). Five patients (6%) had a documented anastomotic leak. Perioperative mo rtality was 3%. No technical factors, including type of resection (low ante rior vs. abdominoperineal), location of tumor, or extent of resection margi n, were significant for determining local recurrence. The only histopatholo gic marker significant for determining local recurrence was lymphatic invas ion (P < 0.04). Sharp mesorectal excision with low anterior resection or ab dominoperineal resection for T3N0M0 rectal cancer results in a local recurr ence rate of less than 10% without the use of adjuvant therapy. Therefore, in select patients with T3N0M0 rectal cancer, the standard use of adjuvant therapy for local control may not be justified.