Survival Outcomes after Total Mesorectal Excision for Rectal Cancer - A Single Institution Experience

Over the past four decades, advancements in multimodality treatments have significantly improved the prognosis of rectal cancer, with the 5 year tumor related survival rate increasing from 60 to 79% and local recurrences rates dropping from 14.3% to 5.3%. This study evaluated the oncological outcomes of total mesorectal excision (TME), including local recurrence and survival rates, along with factors influencing survival in South Indian population. A Total of 190 patients who underwent TME for rectal adenocarcinoma in our centre from 2015 to 2024 were included. Disease free survival and overall survival were assessed using the Kaplan-Meier method. Univariate analysis with log rank test was done on to identify high risk groups based on established risk factors. With a median follow up of 55 months, local recurrence occurred in four (2.7%) patients and distant recurrence occurred in 18 patients (12%). The overall survival rate was 89.4%, with 100% for stage I disease, 94% for stage II, and 73.8% for stage III disease. The disease free survival rate was 87.7%. Univariate analysis identified age under 50 yrs (p = 0.04), baseline CEA levels of above 4 ng/mL (P = 0.001), higher grade (P = 0.04) and patients unable to complete adjuvant chemotherapy (P = 0.03) as significant predictors of poorer overall survival. This study has demonstrates that low local recurrence rates and favourable overall survival can be achieved through multimodality treatment for rectal cancer. Elevated baseline CEA levels, higher tumor grade, and patients unable to complete adjuvant chemotherapy are associated with poorer prognosis.