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Rectal cancer: local recurrence after surgery without radiotherapy
F A Bonadeo1, C A Vaccaro, M L Benati
1Department of Surgery, Hospital Italiano, Buenos Aires, Argentina.
Diseases of the Colon and Rectum
|April 6, 2001
Summary
Excellent local control is achievable for rectal cancer patients without radiotherapy if they have no lymph node metastasis (N0). Factors increasing local recurrence risk include positive nodes, lower rectal tumors, and accidental perforation during surgery.
Area of Science:
- Surgical Oncology
- Gastrointestinal Oncology
- Rectal Cancer Research
Background:
- Rectal cancer treatment often involves radiotherapy, but its necessity without lymph node metastasis is debated.
- Assessing local recurrence rates and predictors after curative resection alone is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the local recurrence rate following curative rectal cancer resection without radiotherapy.
- To identify prognostic factors associated with local recurrence in this patient cohort.
Main Methods:
- A retrospective analysis of 417 patients who underwent curative anterior or abdominoperineal resection for rectal cancer between 1980 and 1996.
- Exclusion criteria included preoperative/postoperative radiotherapy, local resection, and early postoperative death.
- Total mesorectal excision was performed, with chemotherapy reserved for Stage III lesions; median follow-up was 5.2 years.
Main Results:
- The 5-year local recurrence rate was 9.7%. Rates varied significantly by stage (Stage I: 3.1%, Stage II: 4.1%, Stage III: 24.1%) and lymph node status (N0: 4.1% to N3: 59.3%).
- Lower third rectal tumors showed a higher recurrence rate (17.9%) compared to middle (7.1%) and upper (5.1%) thirds, particularly those below 6 cm from the anal verge.
- Accidental rectal perforation near the tumor site (2.9%) was strongly correlated with increased local recurrence (P < 0.0001).
Conclusions:
- Curative resection without radiotherapy provides excellent local control for node-negative (N0) rectal cancers.
- Positive lymph node metastasis, tumors located in the lower third of the rectum (especially <6 cm), and intraoperative rectal perforation are significant risk factors for local recurrence.