The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision

Abstract

Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection

“…It has been shown that preoperative nodal understaging in rectal cancer patients may be related to approximately 15% of patients compared to histological assessment. However, neither the effect of the above finding nor the impact of clinical nodal staging on long-term outcomes was shown [ 32 , 33 ]. We did not find such an impact, although our analysis was conducted on a heterogeneous group of patients (cT3N0, cT1-3N+).…”

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

“…Since then, a series of clinical researches have promoted the discussion about the treatment strategy of cCR patients [ 10 , 11 ]. Compared with TME surgery, the W&W strategy could achieve a similar overall survival and a better preservation of organ anatomy and physiological function [ 12 ]. Some related meta-analyses had published.…”

The clinical effect of total mesorectal excision with lateral lymph node dissection for lower rectal cancer: A systematic review and meta-analysis

“…Other studies had shown that the risk factor of local recurrence was lateral pelvic lymph nodes of a size more than 7 mm in MRI after neoadjuvant therapy 38) . The risk factor of distal recurrence was similar to local recurrence 39) . Therefore, TME with LLND may improve survival outcomes for these patients with the risk factors of lateral lymph node metastases or local recurrence.…”