Skip to main content

Advertisement

SpringerLink
Log in

Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

To investigate the prognosis of adenocarcinomas of the upper third of the rectum and the rectosigmoid-junction without radiotherapy.

Methods

Patients from a multicenter randomized controlled trial from 1987–1993 on adjuvant chemotherapy for R0-resected colorectal cancers with stage I–III disease were retrospectively allocated: cancers of the lower two-thirds of the rectum (11 cm or less from anal-verge, Group A, n = 205), of the upper-third of the rectum and rectosigmoid-junction (>11–20 cm from anal-verge, Group B, n = 142), and of the colon (>20 cm from anal-verge, Group C, n = 378). The total mesorectal excision (TME) technique had not been introduced yet. The adjuvant chemotherapy turned out to be ineffective. None of the patients received neoadjuvant or adjuvant radiotherapy.

Results

The patients had a regular follow-up (median, 8.0 years). The 5-year disease-free survival (DFS) rate was 0.54 (95%CI, 0.47–0.60) in Group A, 0.68 (95%CI, 0.60–0.75) in Group B, and 0.69 (95%CI, 0.64–0.74) in Group C. The 5-year overall survival (OS) rate was 0.64 (95%CI, 0.57–0.71) in Group A, 0.79 (95%CI, 0.71–0.85) in Group B, and 0.77 (95%CI, 0.73–0.81) in Group C. Compared with Group C, patients in Group A had a significantly worse OS (hazard ratio [HR] for death 2.10) and a worse DFS (HR for relapse/death 1.93), while patients in Group B had a similar OS (HR 1.12) and DFS (HR 1.07).

Conclusions

Adenocarcinomas of the upper third of the rectum and the rectosigmoid-junction seem to have similar prognosis as colon cancers. Even for surgeons not familiar with the TME technique, preoperative radiotherapy may be avoided for most rectosigmoid cancers above 11 cm from anal-verge.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482

    Article  CAS  PubMed  Google Scholar 

  2. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van de Velde CJ, Dutch Colorectal Cancer G (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582. doi:10.1016/S1470-2045(11)70097-3

    Article  PubMed  Google Scholar 

  3. Maurer CA, Renzulli P, Kull C, Kaser SA, Mazzucchelli L, Ulrich A, Buchler MW (2011) The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol 18(7):1899–1906. doi:10.1245/s10434-011-1571-0

    Article  CAS  PubMed  Google Scholar 

  4. Maurer CA, Z’Graggen K, Renzulli P, Schilling MK, Netzer P, Buchler MW (2001) Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. Br J Surg 88(11):1501–1505. doi:10.1046/j.0007-1323.2001.01904.x

    Article  CAS  PubMed  Google Scholar 

  5. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, Cooperative Clinical Investigators of the Dutch Colorectal Cancer G (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol: Off J Am Soc Clin Oncol 20(7):1729–1734

    Article  Google Scholar 

  6. Junginger T, Maurer CA, Ruppert R (2013) Commentary on the editorial of Sautter-Bihl et al. in Strahlentherapie und Onkologie 2013 189:105–110. Strahlenther Onkol 189:697–699

    Article  CAS  PubMed  Google Scholar 

  7. Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol: Off J Am Soc Clin Oncol 23(25):6199–6206. doi:10.1200/JCO.2005.14.779

    Article  CAS  Google Scholar 

  8. Bonnel C, Parc YR, Pocard M, Dehni N, Caplin S, Parc R, Tiret E (2002) Effects of preoperative radiotherapy for primary resectable rectal adenocarcinoma on male sexual and urinary function. Dis Colon Rectum 45(7):934–939

    Article  PubMed  Google Scholar 

  9. Pollack J, Holm T, Cedermark B, Altman D, Holmstrom B, Glimelius B, Mellgren A (2006) Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 93(12):1519–1525. doi:10.1002/bjs.5525

    Article  CAS  PubMed  Google Scholar 

  10. Strassburg J, Ruppert R, Ptok H, Maurer C, Junginger T, Merkel S, Hermanek P (2011) MRI-based indications for neoadjuvant radiochemotherapy in rectal carcinoma: interim results of a prospective multicenter observational study. Ann Surg Oncol 18(10):2790–2799. doi:10.1245/s10434-011-1704-5

    Article  PubMed  Google Scholar 

  11. Ruppert R, Ptok H, Strassburg J, Maurer CA, Junginger T, Merkel S, Hermanek P (2012) [Quality indicators of diagnosis and therapy in MRI-based neoadjuvant radiochemotherapy for rectal cancer—interim analysis of a prospective multicentre observational study (OCUM).]. Zentralbl Chir. doi:10.1055/s-0031-1283922

    PubMed  Google Scholar 

  12. Junginger T, Hermanek P (2008) Problems in the treatment of upper rectal carcinoma. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizin 79(4):327–339. doi:10.1007/s00104-008-1467-0

    Article  CAS  Google Scholar 

  13. Lopez-Kostner F, Lavery IC, Hool GR, Rybicki LA, Fazio VW (1998) Total mesorectal excision is not necessary for cancers of the upper rectum. Surgery 124(4):612–617. doi:10.1067/msy.1998.91361

    Article  CAS  PubMed  Google Scholar 

  14. Rosenberg R, Maak M, Schuster T, Becker K, Friess H, Gertler R (2010) Does a rectal cancer of the upper third behave more like a colon or a rectal cancer? Dis Colon Rectum 53(5):761–770. doi:10.1007/DCR.0b013e3181cdb25a

    Article  PubMed  Google Scholar 

  15. Laffer U, Metzger U, Aeberhard P, Lorenz M, Harder F, Maibach R, Zuber M, Herrmann R (2008) Adjuvant perioperative portal vein or peripheral intravenous chemotherapy for potentially curative colorectal cancer: long-term results of a randomized controlled trial. Int J Color Dis 23(12):1233–1241. doi:10.1007/s00384-008-0543-8

    Article  CAS  Google Scholar 

  16. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655

    Article  CAS  PubMed  Google Scholar 

  17. Hermanek P, Sugg SL (1987) UICC. International union against cancer. TNM classification of malignant tumors. Springer-Verlag, Berlin

    Book  Google Scholar 

  18. Kwok SP, Lau WY, Leung KL, Liew CT, Li AK (1996) Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. Br J Surg 83(7):969–972

    Article  CAS  PubMed  Google Scholar 

  19. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 20(24):5644–5650

    Article  Google Scholar 

  20. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Dutch colorectal cancer group: preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 30(9):638–646

    Article  Google Scholar 

  21. Maurer CA (2004) Colon cancer: resection standards. Tech Coloproctol 8(Suppl 1):s29–s32. doi:10.1007/s10151-004-0104-2

    Article  PubMed  Google Scholar 

  22. Steup WH, Moriya Y, van de Velde CJ (2002) Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer 38(7):911–918

    Article  CAS  PubMed  Google Scholar 

  23. Nijkamp J, Kusters M, Beets-Tan RG, Martijn H, Beets GL, van de Velde CJ, Marijnen CA (2011) Three-dimensional analysis of recurrence patterns in rectal cancer: the cranial border in hypofractionated preoperative radiotherapy can be lowered. Int J Radiat Oncol Biol Phys 80(1):103–110. doi:10.1016/j.ijrobp.2010.01.046

    Article  PubMed  Google Scholar 

  24. Salerno G, Sinnatamby C, Branagan G, Daniels IR, Heald RJ, Moran BJ (2006) Defining the rectum: surgically, radiologically and anatomically. Color Dis: Off J Assoc Coloproctol Great Br Ireland 8(Suppl 3):5–9. doi:10.1111/j.1463-1318.2006.01062.x

    Article  Google Scholar 

  25. Sobin LGM, Wittekind C (2009) UICC TNM classification of malignant tumours, 7th edn. John Wiley & Sons, New York

    Google Scholar 

  26. Bagla N, Schofield JB (2007) Rectosigmoid tumours: should we continue sitting on the fence? Color Dis: Off J Assoc Coloproctol Great Br Ireland 9(7):606–608. doi:10.1111/j.1463-1318.2007.01329.x

    Article  CAS  Google Scholar 

  27. Baatrup G, Bolstad M, Mortensen JH (2009) Rigid sigmoidoscopy and MRI are not interchangeable in determining the position of rectal cancers. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol 35(11):1169–1173. doi:10.1016/j.ejso.2009.02.004

    Article  CAS  Google Scholar 

Download references

Authors’ contributions

Study conception and design (JF, QL, UM, MC, UTL, CAM)

Acquisition of data (JF, UM, MC, UTL, CAM)

Analysis and interpretation of data (SAK, JF, QL, SM, UM, MC, UTL, CAM)

Drafting of manuscript (SAK, JF, QL, CAM)

Critical revision of manuscript (SAK, JF, QL, SM, UM, MC, UTL, CAM)

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, Bern, 3008, Switzerland

    S. A. Käser, J. Froelicher, Q. Li, S. Müller, U. Metzger, M. Castiglione, U. T. Laffer & C. A. Maurer

  2. Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Baselland, Liestal, affiliated to the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland

    C. A. Maurer

Authors
  1. S. A. Käser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Froelicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Q. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Metzger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Castiglione
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. T. Laffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. A. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. A. Maurer.

Additional information

S. A. Käser and J. Froelicher contributed equally.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Käser, S.A., Froelicher, J., Li, Q. et al. Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87. Langenbecks Arch Surg 400, 675–682 (2015). https://doi.org/10.1007/s00423-014-1243-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-014-1243-1

Keywords

Search

Navigation