TY - JOUR
T1 - Long-term survival and recurrence outcomes following surgery for distal rectal cancer
AU - Silberfein, Eric J.
AU - Kattepogu, Kiran M.
AU - Hu, Chung Yuan
AU - Skibber, John M.
AU - Rodriguez-Bigas, Miguel A.
AU - Feig, Barry
AU - Das, Prajnan
AU - Krishnan, Sunil
AU - Crane, Christopher
AU - Kopetz, Scott
AU - Eng, Cathy
AU - Chang, George J.
N1 - Funding Information:
ACKNOWLEDGMENT Financial support from National Cancer Institute Core Grant CA16672 (MDACC), an American Society of Clinical Oncology Foundation Career Development Award (G.J.C.), and a National Cancer Institute K07-CA133187 research grant (G.J.C.). The authors would also like to thank Kristi Speights for her assistance with the preparation of this manuscript and Irma Medrano for her technical assistance.
PY - 2010/11
Y1 - 2010/11
N2 - Background: Treatment of distal rectal cancer remains clinically challenging and includes proctectomy and coloanal anastomosis (CAA) or abdominoperineal resection (APR). The purpose of this study is to evaluate operative and pathologic factors associated with long-term survival and local recurrence outcomes in patients treated for distal rectal cancer. Methods: A retrospective consecutive cohort study of 304 patients treated for distal rectal cancer with radical resection from 1993 to 2003 was performed. Patients were grouped by procedure (CAA or APR). Demographic, pathologic, recurrence, and survival data were analyzed utilizing chi-square analysis for comparison of proportions. Survival analysis was performed using Kaplan-Meier method and log-rank test for univariate and Cox regression for multivariate comparison. Results: The median tumor distance from the anal verge was 2 cm [interquartile range (IQR) 0.5-4 cm]. Margins were negative in all but four patients (one distal, 0.3%; three radial, 1%). The 5-year overall survival rate was 82% (88.6% stage pI, 80.5% stage pII, 67.9% stage pIII). Older age, advanced pathologic stage, presence of lymphovascular or perineural invasion, earlier treatment period, and APR surgery type were associated with worse survival on multivariate analysis. The 5-year local recurrence rate was 5.3% after CAA and 7.9% after APR (p = 0.33). Conclusions: Low rates of local recurrence and good overall survival can be achieved after treatment of distal rectal cancer with stage-appropriate chemoradiation and proctectomy with CAA or APR. Sphincter preservation can be achieved even with distal margins less than 2 cm.
AB - Background: Treatment of distal rectal cancer remains clinically challenging and includes proctectomy and coloanal anastomosis (CAA) or abdominoperineal resection (APR). The purpose of this study is to evaluate operative and pathologic factors associated with long-term survival and local recurrence outcomes in patients treated for distal rectal cancer. Methods: A retrospective consecutive cohort study of 304 patients treated for distal rectal cancer with radical resection from 1993 to 2003 was performed. Patients were grouped by procedure (CAA or APR). Demographic, pathologic, recurrence, and survival data were analyzed utilizing chi-square analysis for comparison of proportions. Survival analysis was performed using Kaplan-Meier method and log-rank test for univariate and Cox regression for multivariate comparison. Results: The median tumor distance from the anal verge was 2 cm [interquartile range (IQR) 0.5-4 cm]. Margins were negative in all but four patients (one distal, 0.3%; three radial, 1%). The 5-year overall survival rate was 82% (88.6% stage pI, 80.5% stage pII, 67.9% stage pIII). Older age, advanced pathologic stage, presence of lymphovascular or perineural invasion, earlier treatment period, and APR surgery type were associated with worse survival on multivariate analysis. The 5-year local recurrence rate was 5.3% after CAA and 7.9% after APR (p = 0.33). Conclusions: Low rates of local recurrence and good overall survival can be achieved after treatment of distal rectal cancer with stage-appropriate chemoradiation and proctectomy with CAA or APR. Sphincter preservation can be achieved even with distal margins less than 2 cm.
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U2 - 10.1245/s10434-010-1119-8
DO - 10.1245/s10434-010-1119-8
M3 - Article
C2 - 20552409
AN - SCOPUS:78049468994
SN - 1068-9265
VL - 17
SP - 2863
EP - 2869
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 11
ER -