Aggressive versus conventional strategies in the treatment of rectal adenocarcinoma.
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.


METHODS
Retrospective study.


METHODS
Memorial Sloan-Kettering Cancer Centre, New York (MSKCC) and University Hospital Leiden, the Netherlands (UHL).


METHODS
One hundred and sixty-nine patients treated at MSKCC and 96 patients treated at UHL.


METHODS
Total mesorectal excision (MSKCC) and conventional resection (UHL).


METHODS
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.
Havenga
K
K
Department of Surgery, Memorial Sloan-Kettering Cancer Centre, New York, USA.
Huang
Y
Y
Enker
W E
WE
Welvaart
K
K
De Roy Van Zuidewijn
D B
DB
Cohen
A M
AM
D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate