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Comparative Oncologic Outcomes of Upper Third Rectal Cancers: A Meta-analysis
Cillian Clancy1, Michael Flanagan1, Franco Marinello2
1Departments of Colorectal Surgery and Radiation Oncology, Beaumont Hospital, Dublin, Ireland.
Clinical Colorectal Cancer
|August 26, 2019
Summary
Upper rectal cancer shows lower local and distant recurrence rates compared to lower rectal cancer, even with similar disease stages. This suggests upper rectal tumors may warrant distinct treatment considerations.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Preoperative radiation and mesorectal excision improve rectal cancer outcomes.
- The efficacy of neoadjuvant therapy for upper third rectal cancer is not well-defined.
Purpose of the Study:
- To compare outcomes of upper third rectal tumors versus middle and lower rectal tumors using meta-analysis.
- To evaluate recurrence rates in distinct rectal cancer locations.
Main Methods:
- Meta-analysis conducted following PRISMA guidelines.
- Included studies compared upper vs. distal rectal cancer patients undergoing primary resection.
- Excluded patients receiving neoadjuvant treatment.
Main Results:
- Analyzed 5 studies with 3381 patients.
- No significant difference in T3/4 tumors, lymph node positivity, or margin positivity.
- Reduced local recurrence (OR 0.495) and distant recurrence (OR 0.613) in upper rectal cancer.
Conclusions:
- Upper rectal cancer demonstrates lower recurrence rates than distal rectal cancer.
- Disease stage and margin positivity were similar between groups.
- Upper rectal tumors should be considered a distinct entity in future research.
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