Results of curative surgery and postoperative chemoradiation for rectal adenocarcinoma in British Columbia, 1985 to 1994

Objective: To assess factors affecting survival and pelvic recurrence after surgery and postoperative chemoradiation for rectal cancer in order to des ign improved management strategies. Design: A chart review. Setting: The Br itish Columbia Cancer Agency. Patients: One hundred and ninety-one consecut ive patients who had rectal cancer treated between 1985 and 1994. Median fo llow-up was 39 months. Interventions: Surgical excision of the cancer with intent to cure followed by chemoradiation. Outcome measures: Multivariate a nalysis, to determine whether survival and pelvic recurrence were affected by turnout stage, nodal status, type of surgical procedure and presence of residual disease, and the quality of pathology reporting with respect to ev aluation of radial resection margins and number of lymph nodes examined. Re sults: Overall 5-year disease-specific survival was 60% and pelvic recurren ce was 25%. Survival was affected by tumour stage (p < 0.02), nodal status (p < 0.001), type of surgical procedure (p < 0.04), presence of residual di sease (p < 0.02) and pelvic recurrence (p < 0.0001). Pelvic recurrence was affected by the presence of residual disease (p < 0.001) but not by tumour stage (p < 0.14), nodal status (p < 0.37) or type of surgical procedure (p < 0.20). Radial margins were evaluated in 44% of pathology reports and the median number of lymph nodes assessed was 6. Conclusions: Survival was most significantly affected by pelvic recurrence. Strategies to minimize pelvic recurrence including preoperative radiation and the principle of careful m esorectal excision to maximize the achievement of negative radial resection margins and negative residual disease are recommended. Also needed are sta ndards for evaluating radial margins and lymph nodes to improved pathology reports.