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01.11.2010 | Colorectal Cancer | Ausgabe 11/2010

Annals of Surgical Oncology 11/2010

Long-Term Survival and Recurrence Outcomes Following Surgery for Distal Rectal Cancer

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 11/2010
Autoren:
MD Eric J. Silberfein, MS Kiran M. Kattepogu, MPH Chung-Yuan Hu, MD John M. Skibber, MD Miguel A. Rodriguez-Bigas, MD Barry Feig, MD Prajnan Das, MD Sunil Krishnan, MD Christopher Crane, MD Scott Kopetz, MD Cathy Eng, MD, MS George J. Chang

Abstract

Background

Treatment of distal rectal cancer remains clinically challenging and includes proctectomy and coloanal anastomosis (CAA) or abdominoperineal resection (APR). The purpose of this study is to evaluate operative and pathologic factors associated with long-term survival and local recurrence outcomes in patients treated for distal rectal cancer.

Methods

A retrospective consecutive cohort study of 304 patients treated for distal rectal cancer with radical resection from 1993 to 2003 was performed. Patients were grouped by procedure (CAA or APR). Demographic, pathologic, recurrence, and survival data were analyzed utilizing chi-square analysis for comparison of proportions. Survival analysis was performed using Kaplan–Meier method and log-rank test for univariate and Cox regression for multivariate comparison.

Results

The median tumor distance from the anal verge was 2 cm [interquartile range (IQR) 0.5–4 cm]. Margins were negative in all but four patients (one distal, 0.3%; three radial, 1%). The 5-year overall survival rate was 82% (88.6% stage pI, 80.5% stage pII, 67.9% stage pIII). Older age, advanced pathologic stage, presence of lymphovascular or perineural invasion, earlier treatment period, and APR surgery type were associated with worse survival on multivariate analysis. The 5-year local recurrence rate was 5.3% after CAA and 7.9% after APR (p = 0.33).

Conclusions

Low rates of local recurrence and good overall survival can be achieved after treatment of distal rectal cancer with stage-appropriate chemoradiation and proctectomy with CAA or APR. Sphincter preservation can be achieved even with distal margins less than 2 cm.

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