Skip to main content
Log in

Prognostic factors in Stage T2NO rectal cancer

Do all patients require postoperative pelvic irradiation and chemotherapy?

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum


PURPOSE: To further define the indications for postoperative pelvic irradiation and chemotherapy, an analysis of the influence of extent of tumor invasion into perirectal fat, lymphatic or venous vessel invasion, and tumor grade on the clinical course of patients with Stage T2NO rectal cancer undergoing surgery was undertaken. METHODS: From 1968 to 1985, 117 patients with Stage T3NO rectal cancer underwent resection with curative intent. No patient received neoadjuvant or adjuvant irradiation or chemotherapy. Surgical specimens were assessed for maximum depth of tumor invasion into perirectal fat, lymphatic or venous involvement, and tumor grade. After surgery the clinical course of these patients was assessed for local control, distant metastases, and survival rate. RESULTS: For 25 patients with tumors exhibiting favorable histologic features (well-differentiated or moderately well-differentiated carcinomas invading less than 2 mm into perirectal fat, without lymphatic or venous vessel involvement), the ten-year actuarial rates of local control and recurrence-free survival were 95 and 87 percent, respectively. In contrast, the ten-year actuarial rates of local control and recurrence-free survival were inferior (71 and 55 percent, respectively) for 88 patients with tumors exhibiting moderate to deep perirectal fat invasion, vessel involvement, or poor differentiation. CONCLUSIONS: In the design of future trials of rectal cancer, selection of patients with rectal cancer for postoperative adjuvant therapy should be based not only on stage, but also on depth of invasion into the perirectal fat, vessel involvement, tumor grade, and integrity of the radial resection margin. For subsets of patients with Stage T3NO rectal cancer, there may be little benefit to adjuvant therapy after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following curative surgery for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.

    PubMed  Google Scholar 

  2. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–29.

    PubMed  Google Scholar 

  3. Vigliotti A, Rich TA, Romsdahl M, Withers HR, Oswald MJ. Postoperative adjuvant radiotherapy for adenocarcinoma of the rectum and rectosigmoid. Int J Radiat Oncol Biol Phys 1987;13:999–1006.

    PubMed  Google Scholar 

  4. Schild SE, Martenson JA, Gunderson LL,et al. Postoperative adjuvant therapy of rectal cancer: an analysis of disease control, survival and prognostic factors. Int J Radiat Oncol Biol Phys 1989;17:55–62.

    PubMed  Google Scholar 

  5. Willett CG, Tepper JE, Kaufman DS,et al.: Adjuvant postoperative radiation therapy for rectal adenocarcinoma. Am J Clin Oncol 1992;15:371–5.

    PubMed  Google Scholar 

  6. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72.

    Google Scholar 

  7. Krook JE, Moertel CG, Gunderson LL,et al. Effective surgical adjuvant therapy for high-risk rectal cancer. N Engl J Med 1991;324:709–15.

    PubMed  Google Scholar 

  8. Gastrointestinal Tumor Study Group. Radiation therapy and 5-FU with or without semustine for the treatment of patients with surgical adjuvant adenocarcinoma of the rectum. J Clin Oncol 1992;10:549–57.

    Google Scholar 

  9. O'Connell MJ, Martenson JA, Wieand HS,et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1995;331:502–7.

    Article  Google Scholar 

  10. Tepper JE, O'Connell MJ, Petroni GR,et al. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of Intergroup 0114. J Clin Oncol 1997;15:2030–9.

    PubMed  Google Scholar 

  11. NIH Consensus Conference. Adjuvant therapy for patients with colorectal cancer. JAMA 1990;264:1444–50.

    Google Scholar 

  12. Kollmorgen CF, Meagher AP, Wolff BG, Pemberton JH, Martenson JA, Ilstrup DM. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220:676–82.

    PubMed  Google Scholar 

  13. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumor spread and surgical excision. Lancet 1986;2:996–9.

    Article  PubMed  Google Scholar 

  14. Adam IJ, Mohamdee MO, Martin IG,et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994;344:707–11.

    Article  PubMed  Google Scholar 

  15. MacFarlane JK, Ryall RD, Heald RJ: Mesorectal excision for rectal cancer. The Lancet 1993;341:457–60.

    Article  Google Scholar 

  16. Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995;181:335–46.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


About this article

Cite this article

Willett, C.G., Badizadegan, K., Ancukiewicz, M. et al. Prognostic factors in Stage T2NO rectal cancer. Dis Colon Rectum 42, 167–173 (1999).

Download citation

  • Issue Date:

  • DOI:

Key words