Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis

Abstract

Summary Factors influencing time to loco-regional recurrence were identified in a multivariate regression analysis of data from a series of 468 radically operated patients (260 Dukes' B and 208 Dukes' C) with carcinoma of the rectum and the rectosigmoid. A number of clinical and pathological characteristics were prospectively collected and recorded. In addition, carcinoembryonic antigen (CEA) was measured within I week before surgery. The endpoint used was recurrence below the level of the umbilicus. All patients were followed for at least 5 years or until time of death.The two Dukes' stages B and C were analysed in two separate analyses using the Cox proportional hazards model. In patients with Dukes' B tumours, an increased risk of loco-regional recurrence was associated with perineural invasion, tumour located less than 10 cm from the anal verge, patient aged above 70 years, and small tumour size. In patients with Dukes' C tumours, the necessity to resect neighbour organs, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and large tumour size were all associated with a poor loco-regional outcome. Postoperative radiotherapy was not a significant prognosticator for loco-regional control.An update of the 5-year results of the randomised study of post-operative radiotherapy (50 Gy with 2 Gy per fraction in an overall treatment time of 7 weeks) showed no survival benefit from adjuvant radiotherapy in either Dukes' category and no statistically significant improvement in the 5-year loco-regional control rate. However, when the comparison was restricted to a group of high-risk patients there was a statistically significant benefit from radiotherapy with respect to loco-regional control (P = 0.03) but not with respect to survival (P = 0.23). The potential advantage, in terms of the required number of patients, of restricting clinical trials of intensified loco-regional therapies to the high-risk patients, is illustrated.

Local recurrence and survival after laparoscopic mesorectal resection for rectal adenocarcinoma

“…In this study, 35% of the patients underwent laparoscopic APR. This rate is not different from that of many recent studies in reputable centers (Table 5) [3,7,8,10,12,18,23,26,30,45] and the rate of APR for open surgery in our center during the same period (36%). However, exceptional APR rates of 15% or lower are beginning to appear, backed by excellent long-term oncologic outcomes [23].…”

Long-Term Outcome After Operative Intervention for Rectal Cancer in Patients Aged Over 80 Years: Analysis of 9,501 Patients

“…The risk of local recurrence in elderly patients with rectal cancer also is reportedly high. [16][17][18][19] This may be attributed to diagnostic delay, biologic behavior, which may be more aggressive, and less intense surgery. Side effects after preoperative radiotherapy may be more severe in elderly patients.…”

Perineural invasion in pT3N0 rectal cancer

“…23 Similar results were also obtained by other studies. 30,31,38 However, most of these studies combined colon and rectal cancer or cancer with different stages together. pT3N0 rectal cancer, which was one of the most controversial areas in the management of colorectal cancer, was seldom focused on specifically.…”