Abstract
Purpose
Patients and clinicians seek an accurate prognosis after resectional surgery for rectal cancer. The aim of this study was to determine long-term outcomes after potentially curative surgery for rectal cancer with particular focus on factors associated with longer-term survival that are available to surgeons in the early post-operative setting.
Methods
We conducted a retrospective review of a prospectively gathered database of all primary rectal adenocarcinomas considered for surgery in the University Hospitals of Leicester National Health Service (NHS) Trust between 1998 and 2007. Survival was calculated using a Kaplan–Meier method. Factors thought to be associated with survival were subjected to univariate analysis followed by Cox proportion regression.
Results
One thousand and twelve patients with primary rectal adenocarcinoma diagnosed between 1998 and 2007 were identified. Eight hundred and fifty three patients did not have metastases at the time of presentation and 726 patients underwent major resectional surgery. Five-year survival was 66 %. Patients' age, Dukes' stage, UICC stage, nodal involvement and circumferential resection margin status were independently associated with long-term survival on multivariate analysis.
Conclusion
This is one of the largest series of rectal cancers from a single NHS trust. We have demonstrated that age, Dukes' stage and CRM status are associated with long-term survival. These clinical factors are readily available to the surgeon at the time of first post-operative review and can provide a good clinical guide to prognosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
How P, Shihab O, Tekkis P, Brown G, Quirke P, Heald R et al (2011) A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 20(4):e149–e155
West NP, Anderin C, Smith KJ, Holm T, Quirke P, European Extralevator Abdominoperineal Excision Study Group (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97(4):588–599
Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820
Office for National Statistics. Interim life tables, 2008–2010. Available at: http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-223324. Accessed Sep 2011.
Tekkis PP, Heriot AG, Smith J, Thompson MR, Finan P, Stamatakis JD et al (2005) Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer. Colorectal Dis 7(4):369–374
Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Soreide O et al (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47(1):48–58
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133(8):894–899
den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF et al (2009) The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 45(7):1175–1183
West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P (2008) Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 26(21):3517–3522
Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH, Pathology Review Committee et al (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26(3):350–357
Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344(8924):707–711
Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection Histopathological study of lateral tumour spread and surgical excision. Lancet 2(8514):996–999
Bernstein TE, Endreseth BH, Romundstad P, Wibe A, Norwegian Colorectal Cancer Group (2009) Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 96(11):1348–1357
Acknowledgments
The authors would like to thank the following members of the Leicester Specialist Colorectal Advisory Group: D Hemingway, J Jameson, A Miller, M Norwood, A Scott, B Singh, M Thomas, J Yeung, K Boyle, S Chaudhri, S Campbell, A Cocks, T Cook, J de Caestecker, T Delahooke, E Edwards, M Elabassy, A Grant, L Greening, S Headley, M Hill, J Jankowski, R Kenningham, J Masterman, J Mayberry, A McGregor, K Mulcahy, C Newland, A Osman, A Rajesh, B Rathbone, Y Rees, C Richards, R Robinson, P Rodgers, V Shah, S Shallow, D Sharpe, T Sridhar, D Stark, W Steward, A Thomas, S Vasanthan, R Verma, K West, D Weston-Price, P Wurm.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bown, E.J., Lloyd, G.M., Boyle, K.M. et al. Rectal cancer: prognostic indicators of long-term outcome in patients considered for surgery. Int J Colorectal Dis 29, 147–155 (2014). https://doi.org/10.1007/s00384-013-1772-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-013-1772-z