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Updated: May 21, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Improved local control of rectal cancer reduces distant metastases
T E Bernstein1, B H Endreseth, P Romundstad
1Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. tor.bernstein@stolav.no
Aim:
The purpose of the present national study was to determine whether improved local control has been accompanied by a change in the incidence of metastases.
Method:
The data were from a national population-based rectal cancer registry and included all 6501 rectal cancer patients treated for cure. The study periods were 1993-1997, 1998-2000, 2001-2003 and 2004-2006.
Results:
Major changes in the handling of rectal cancer from the first to the last study period included an increased use of MRI from zero to 81% and the use of preoperative radiotherapy from 5% to 20%. The proportion of patients with circumferential resection margin (CRM) ≤2mm decreased from 23% to 13%. The 4-year rate of local recurrence decreased from 13% to 8% (P<0.001), the overall survival increased from 65% to 73% (P<0.001) and the incidence of distant metastases decreased from 25% to 19% (P<0.001) from the first to the last period. The risk of metastases decreased by 29% (hazard ratio 0.71, 95% CI 0.60-0.84).
Conclusion:
Improved diagnostics and treatment of rectal cancer aiming at better local control and survival have resulted in a significant reduction in the incidence of distant metastases.
