Impact of surgical and pathologic variables in rectal cancer: A United States Community and Cooperative Group Report

Purpose: Substantial and successful effort has been focused on decreasing t he risk of local failure after rectal cancer surgery through the use of adj uvant therapies. Our study examined data from studies conducted by United S tates cooperative groups to investigate the impact of surgical and patholog ic variables in rectal cancer outcomes. Patients and Methods: Surgical and pathologic reports from 673 patients wit h stage II/III rectal cancer enrolled onto three adjuvant clinical trials w ere reviewed for tumor and surgical variables. Additional information on in dividual institutions and operating surgeon was collected. Variables were t ested for association with 5-year local recurrence and survival after adjus tment for adjuvant treatments and other important prognostic factors. Results: Five-year local recurrence and survival rates were 16% and 59%, re spectively. Surgeons treating more than 10 study cases had lower local recu rrence rates than those treating less than or equal to 10 (11% v 17%, P = . 02). Free radial margins also correlated with local recurrence (P = .01). T ype of surgery, distal margins, and tumor radial spread were not significan t. Tumor adherence to adjacent structures predicted local recurrence (35% v 14%, P < .001) and survival (30% v 63%, P < .001), regardless of en bloc r esection. Although T and N classification predicted survival (P < .001), on ly N classification correlated with local recurrence. The number and percen tage of positive nodes correlated with survival, but only the percentage in dependently predicted local recurrence. Several pathologic and surgical var iables were reported suboptimally. Conclusion: Moderate variability in outcomes among surgeons was detected in this high-risk population. Efforts to improve surgical results will requir e changes in reporting practices to allow for more accurate assessment of t he quality of surgery. J Clin Oncol 19:3895-3902. (C) 2001 by American Soci ety of Clinical Oncology.