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Surgical Results and Oncologic Outcomes for Rectal Cancer with Tailored Mesorectal Excision over Two Decades

World Journal of Surgery volume 40, pages 1500–1508 (2016)Cite this article

Abstract

Objective

This study aimed to compare the characteristics of the tumors, the management strategy, and oncologic outcomes of patients with rectal cancer surgery in these two periods: period 1 (1993–2001) and period 2 (2002–2011).

Methods

All patients who underwent radical resection of rectal cancer from 1993 to 2011 were included. Comparisons of the patients’ demographics, characteristics, operating results, and oncologic outcome between the two periods were undertaken.

Results

Radical resection for rectal cancer was performed in 1611 patients (993 men). Patients were significantly older and more had comorbid medical diseases in period 2. More laparoscopic resections were performed and more patients had preoperative chemoradiation in period 2. The postoperative mortality was significantly lower and the hospital stay was significantly shorter in period 2. In those with non-metastatic cancer, the 5-year local recurrences of patients in period 1 and period 2 were 11.9 and 5.9 %, respectively. (p = 0.002) The patients in period 2 had significantly better 5-year overall (68.1 vs. 60.2 %, p = 0.003) and 5-year cancer-specific survival (76.1 vs. 69.4 %, p < 0.001) when compared with those treated in period 1. The improvement occurred mainly in patients with abdominoperineal resection and those with stage III diseases. In the multivariate analysis, among the other histological factors, operations performed in period 2 and laparoscopic surgery were independent factors associated with better overall survival.

Conclusions

Significant improvement in the surgical outcomes in terms of a lower recurrence rate and better survival was achieved in the recent years with the increase in neoadjuvant therapy and the application of laparoscopic surgery.

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Affiliations

  1. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Wai Lun Law & Dominic C. C. Foo

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  1. Wai Lun Law
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  2. Dominic C. C. Foo
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Correspondence to Wai Lun Law.

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Law, W.L., Foo, D.C.C. Surgical Results and Oncologic Outcomes for Rectal Cancer with Tailored Mesorectal Excision over Two Decades. World J Surg 40, 1500–1508 (2016). https://doi.org/10.1007/s00268-016-3408-2

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  • DOI: https://doi.org/10.1007/s00268-016-3408-2

Keywords

  • Rectal Cancer
  • Total Mesorectal Excision
  • Oncologic Outcome
  • Laparoscopic Resection
  • Abdominoperineal Resection