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Outcome of Anterior Resection for Stage II Rectal Cancer Without Radiation: The Role of Adjuvant Chemotherapy

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Diseases of the Colon & Rectum

BACKGROUND

This study aimed to evaluate the oncological outcome of patients who had Stage II rectal cancer and underwent curative nonsphincter-ablation surgery without adjuvant radiation.

PATIENTS AND METHODS

During the study period from August 1993 to December 2002, 224 patients (141 men) with Stage II cancer underwent curative anterior resection or Hartmann’s procedure without adjuvant radiation. Data were collected prospectively. The oncologic outcomes of these patients were studied and the risk factors for recurrence and survival were analyzed.

RESULTS

The median age of the patients was 69 (range, 27–89) years and the median level of the tumor from the anal verge was 8 (range, 3–20) cm. Four patients (1.8 percent) died in the postoperative period and postoperative complications occurred in 74 patients (33 percent). The median follow-up time of the surviving patients was 43.6 months. The actuarial five-year recurrence rate was 25.4 percent, whereas the five-year actuarial local and systemic recurrence rates were 6.1 percent and 20 percent, respectively. On multivariate analysis, independent factors associated with a higher recurrence rate included lymphovascular invasion, perineural invasion, and absence of chemotherapy. The overall and cancer-specific survival rates of the patients were 71.1 percent and 81.1 percent, respectively. On multivariate analysis, only adjuvant chemotherapy (<ITALIC>P</ITALIC> = 0.024; hazard ratio = 6.04; 95 percent confidence interval, 1.27–28.74) and the absence of lymphovascular invasion (P = 0.002; hazard ratio = 3.77; 95 percent confidence interval, 1.63–8.77) were independent factors associated with significantly better cancer-specific survival.

CONCLUSION

A low local recurrence rate can be achieved in patients with Stage II rectal cancer treated with nonsphincter-ablation surgery without adjuvant radiation. Postoperative chemotherapy is associated with a lower recurrence rate and higher survival rates. Further study is warranted to define the role of adjuvant chemotherapy in patients with rectal cancer.

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Authors and Affiliations

  1. Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong

    Wai Lun Law M.S., F.R.C.S.(Edinb.), Judy W. C. Ho M.B.B.S., F.R.C.S.(Edinb.), F.R.C.S.(Engl.) , Raymond Chan M.B.B.S., F.R.C.R. (U.K.), Gordon Au M.B.B.S., F.R.C.R.(U.K.),  & Kin Wah Chu M.B.B.S., F.R.C.S. (Edinb)

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  1. Wai Lun Law M.S., F.R.C.S.(Edinb.)
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  2. Judy W. C. Ho M.B.B.S., F.R.C.S.(Edinb.), F.R.C.S.(Engl.)
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  3. Raymond Chan M.B.B.S., F.R.C.R. (U.K.)
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  4. Gordon Au M.B.B.S., F.R.C.R.(U.K.),
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  5. Kin Wah Chu M.B.B.S., F.R.C.S. (Edinb)
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© The American Society of Colon and Rectal Surgeons

Published online: 28 January 2005.

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Law, W., Ho, J., Chan, R. et al. Outcome of Anterior Resection for Stage II Rectal Cancer Without Radiation: The Role of Adjuvant Chemotherapy. Dis Colon Rectum 48, 218–226 (2005). https://doi.org/10.1007/s10350-004-0813-7

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  • DOI: https://doi.org/10.1007/s10350-004-0813-7

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