[Prognostic factors in local recurrence rate after surgical therapy of rectal carcinomas]

From January 01, 1985 to December 31, 1993 515 patients with primary rectal cancer underwent operative treatment at the hospital of general and abdominal surgery of the university of Mainz. In 294 patients with conventional surgical treatment and R0-resection of the tumor we investigated the influence of tumor-, patient- and therapeutic factors on local tumor recurrence. At a univariate analysis the following factors were significant: UICC-staging (p = 0.001), pT-classification (p = 0.001), pN-classification (p = 0.013) and localisation of the tumor (p = 0.013). These results could be verified for the pT-classification and pN-classification in a multivariate analysis. The significant influence of operative treatment (p = 0.034), blood transfusion (p = 0.018) and preoperative raised CEA (p = 0.026) depended on significant differences of UICC - staging and tumor - localisation of the different groups. Grading, sex and age had no influence. Inspite of a shift of local resurrence from 13% to 50% (0% to 42.9% for resections, respectively 6.7% to 55.4% for exstirpations) we could not find a significant influence of the surgeon. This fact depended on the dividing of a small number of cases on a lot of surgeons. In our opinion the influence of the surgeon or of different hospitals on local recurrence should be investigated in further studies.