Curative resection for stage I rectal cancer: natural history, prognostic factors, and recurrence patterns

Our goal was to evaluate the recurrence patterns and outcomes of a large group of patients with stage I rectal adenocarcinoma treated at a single institution with uniform surgical and pathological techniques. Medical records of 71 patients who had undergone potentially curative surgery were reviewed to determine clinical and histologically significant prognostic factors that could affect survival and recurrence patterns. The median follow-up for all patients was 81 months. Twenty patients had T1N0M0 cancers and 51 patients had T2N0M0 cancers. The median number of lymph nodes examined per surgical specimen was 32. There were no recurrences in the 20 patients with T1 lesions. All 7 recurrences (10%) occurred in patients with T2 lesions. Only 2 of these recurrences were local. In the T2 group, the 5- and 10-year disease-free survivals were 88% and 83%, respectively. The 5- and 10-year disease-free survival for all state I lesions was 91% and 88%, respectively. The overall recurrence rate of 10% does not justify adjuvant therapy for stage I rectal adenocarcinoma. Although the subset of patients with T2N0M0 distal one-third rectal cancers may be at risk for recurrence, additional prognostic factors are needed to evaluate these patients before adjuvant therapy can be recommended.