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Aggressive versus conventional strategies in the treatment of rectal adenocarcinoma
K Havenga1, Y Huang, W E Enker
1Department of Surgery, Memorial Sloan-Kettering Cancer Centre, New York, USA.
Objective:
Comparison of an aggressive approach (including total mesorectal excision and combined modality adjuvant therapy) with a conventional approach in the treatment of primary rectal cancer.
Design:
Retrospective study.
Setting:
Memorial Sloan-Kettering Cancer Centre, New York (MSKCC) and University Hospital Leiden, the Netherlands (UHL).
Subjects:
One hundred and sixty-nine patients treated at MSKCC and 96 patients treated at UHL.
Interventions:
Total mesorectal excision (MSKCC) and conventional resection (UHL).
Main Outcome Measures:
Overall survival and local recurrence-free survival.
Results:
Five-year overall survival was 73% for MSKCC patients and 52% for UHL patients (P < 0.001). Five-year local recurrence-free survival was 83% for MSKCC patients and 72% for UHL patients (P=0.001). Relative risk of dying or developing a local recurrence was 3.37 and 2.61, respectively, for patients treated at UHL compared to patients treated at MSKCC (P<0.001 and P=0.008, respectively).
Conclusions:
These data suggest that an aggressive approach including total mesorectal excision and combined modality adjuvant therapy improves survival and local control compared to a conventional approach.