Long-term survival after curative resection for carcinoma of the rectum

The clinical outcome of 453 patients with histologically confirmed adenocarcinoma surveyed from 1980 to 1992 was evaluated. Special consideration was given to the prognostic significance of local recurrence and distant metastases as the significant contributors to postoperative morbidity and mortality. Of 453 patients, 371 were treated by a curative surgical approach. The remaining 82 patients, with extended disease, received palliative treatment. Among those undergoing surgical treatment, the local recurrence rate was 11.3 percent; the incidence of distant metastases was 16.2 percent, and 2.7 percent of the patients exhibited combined lesions. The five-year survival rate depended on the extent of the primary lesion and lymph node status--it was highest for patients with stage I adenocarcinoma (80 percent), a rate significantly better (p < 0.01) than patients with stage II disease (40 percent), who fared better (p < 0.02) than patients with stage III disease (30 percent) (Union Internatinale Contre le Cancer [International Union Against Cancer] classification). Sixty percent of the patients with local recurrence and almost 70 percent with distant spread showed proof of failure within two years. Of 42 patients with local failure, 12 underwent reoperation without leaving residual tumor (RO-treatment) but exhibited no improvement in five-year survival compared with those with no second surgical approach. The operative techniques were abdominoperineal resection (36.9 percent), low anterior resection (58.2 percent) and transanal resection (4.9 percent). They were without significant influence on long term results. Critical analysis of the data emphasizes the urgency of adjuvant treatment for patients with poor long term prognosis, as given for stages IIB and III.