Results of curative surgery and postoperative chemoradiation for rectal adenocarcinoma in British Columbia, 1985 to 1994.
OBJECTIVE
To assess factors affecting survival and pelvic recurrence after surgery and postoperative chemoradiation for rectal cancer in order to design improved management strategies.


METHODS
A chart review.


METHODS
The British Columbia Cancer Agency.


METHODS
One hundred and ninety-one consecutive patients who had rectal cancer treated between 1985 and 1994. Median follow-up was 39 months.


METHODS
Surgical excision of the cancer with intent to cure followed by chemoradiation.


METHODS
Multivariate analysis, to determine whether survival and pelvic recurrence were affected by tumour stage, nodal status, type of surgical procedure and presence of residual disease, and the quality of pathology reporting with respect to evaluation of radial resection margins and number of lymph nodes examined.


RESULTS
Overall 5-year disease-specific survival was 60% and pelvic recurrence was 25%. Survival was affected by tumour stage (p < 0.02), nodal status (p < 0.001), type of surgical procedure (p < 0.04), presence of residual disease (p < 0.02) and pelvic recurrence (p < 0.0001). Pelvic recurrence was affected by the presence of residual disease (p < 0.001) but not by tumour stage (p < 0.14), nodal status (p < 0.37) or type of surgcial procedure (p < 0.20). Radial margins were evaluated in 44% of pathology reports and the median number of lymph nodes assessed was 6.


CONCLUSIONS
Survival was most significantly affected by pelvic recurrence. Strategies to minimize pelvic recurrence including preoperative radiation and the principle of careful mesorectal excision to maximize the achievement of negative radial resection margins and negative residual disease are recommended. Also needed are standards for evaluating radial margins and lymph nodes to improved pathology reports.
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British Columbia Cancer Agency and St. Paul's Hospital, University of British Columbia, Vancouver.
Phang
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D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome