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Rectal cancer with macroscopic peritoneal involvement--clinical challenges and consequences
H K Sigurdsson1, H Kørner, O Dahl
1Department of Surgery, Stavanger University Hospital, PB 8100, Stavanger N-4068, Norway. helgiks@gmail.com
Clinical peritoneal involvement (CPI) significantly worsens survival and increases local recurrence rates in rectal cancer patients without metastases. Identifying CPI is crucial for planning effective adjuvant treatment strategies.
Area of Science:
- Oncology
- Surgical Gastroenterology
- Clinical Research
Background:
- Serosal involvement in gastrointestinal cancers signifies advanced disease.
- Clinical peritoneal involvement (CPI) is a macroscopic indicator of advanced disease in rectal cancer (RC).
Purpose of the Study:
- To investigate the prognostic impact of CPI on local recurrences (LRs) and overall survival in rectal cancer patients.
- To evaluate the role of CPI in the context of different surgical resection types (resective vs. nonresective) and outcomes (R0, R1, R2).
Main Methods:
- Retrospective analysis of 6404 rectal cancer patients diagnosed between 1993 and 2002.
- Identification of 166 patients (3%) with CPI based on surgical and histological findings.
- Stratification of surgical procedures into resective/nonresective and curative (R0)/noncurative (R1/R2) resections.
Main Results:
- CPI was a significant negative prognostic factor for survival (15 months with CPI vs. 65 months without, P < 0.001).
- In R0 resections, median survival was 48 months with CPI versus 97 months without (P < 0.001).
- Local recurrence rates were higher in patients with CPI (15.7%) compared to those without (10.2%, P = 0.022).
Conclusions:
- Clinical peritoneal involvement is a significant detrimental prognostic factor for local recurrence and survival in rectal cancer, even without distant metastases.
- These findings from a large national cohort emphasize the importance of considering CPI in treatment planning.
- Diagnosed CPI necessitates careful consideration in the development of adjuvant treatment strategies for rectal cancer patients.
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