title: Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the west Netherlands.
abstract: OBJECTIVE
  We carried out a population-based study of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1988 and 1992. The first objective was to make an inventory of the overall local recurrence rate after non-standardized conventional surgery, inter-institutional recurrence rate variability, and correlations between patient- and tumour-related factors and recurrence rate. A second objective was to investigate the compliance to guidelines for post-operative radiotherapy.
  
  
  METHODS
  Data were obtained from the Comprehensive Cancer Centre West. The study comprised 1105 patients from 12 hospitals. Of these patients, 437 were ineligible because of missing medical records, no carcinoma, incorrect registration, no laparotomy, non-curative resection, or loss to follow-up.
  
  
  RESULTS
  The overall local recurrence rate was 22.5% with a range of 9-36% between the hospitals. These differences were not significant. Dukes' Astler-Coller stage, tumour location, and residual tumour were significant independent prognostic factors for the risk of local recurrence. Indications for post-operative radiotherapy were Dukes' Astler-Coller B2 and C tumours, positive surgical margins, and tumour spill. Compliance to the guidelines for radiotherapy was only 50%. However, no significant difference in recurrence rate was found between patients treated according to the guidelines and those not treated according to the guidelines.
  
  
  CONCLUSIONS
  This study shows a large variability in local recurrence rate between the participating hospitals and confirms that the risk of recurrence in primary rectal cancer is dependent on Dukes' Astler-Coller stage, tumour location and residual tumour. Furthermore, this study contributes to the discussion about the feasibility of guidelines for post-operative radiotherapy.
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Kapiteijn
authors.forename: C A
authors.initials: CA
authors.lastname: Marijnen
authors.forename: A C
authors.initials: AC
authors.lastname: Colenbrander
authors.forename: E
authors.initials: E
authors.lastname: Klein Kranenbarg
authors.forename: W H
authors.initials: WH
authors.lastname: Steup
authors.forename: J H
authors.initials: JH
authors.lastname: van Krieken
authors.forename: J C
authors.initials: JC
authors.lastname: van Houwelingen
authors.forename: J W
authors.initials: JW
authors.lastname: Leer
authors.forename: C J
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis