Prognostic significance of both surgical and pathological assessment of curative resection for rectal cancer.
BACKGROUND
Information on whether surgery has been 'curative' is essential for prediction of prognosis and for selection of patients for adjuvant treatment. The aim of this study was to analyse the prognostic value of surgeons' and pathologists' assessments of tumour clearance in patients with primary rectal cancer who underwent resection.


METHODS
A total of 1550 patients were studied prospectively. Data were collected from reports made by surgeons and pathologists on whether tumour clearance had been 'complete', 'uncertain' or 'incomplete'. The predictive value in relation to outcome after at least 5 years of follow-up was assessed.


RESULTS
In patients assessed as having a complete surgical clearance, tumour recurrence developed in 33.3 per cent. For patients with an uncertain or incomplete clearance the recurrence rate was 59.5 and 61 per cent respectively (P < 0.001). The relative risk of recurrence was twice as high when the surgeon and pathologist disagreed than when they both agreed on the complete clearance. Survival in patients with a complete, uncertain or incomplete surgical clearance was 55.3, 23.0 and 10 per cent respectively (P = 0.050).


CONCLUSIONS
Assessments of tumour clearance were of strong prognostic value in relation to outcome. When the surgeon or pathologist was uncertain, or there was disagreement about the completeness of clearance, the risk of recurrence was similar to that among patients in whom an incomplete resection had been performed.
Martling
A
A
Department of Surgery, Karolinska Hospital, Stockholm, Sweden. anna.martling@ks.se
Singnomklao
T
T
Holm
T
T
Rutqvist
L E
LE
Cedermark
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000592:standards*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D015588:Observer Variation; D010336:Pathology / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012680:Sensitivity and Specificity; D016019:Survival Analysis