title: The long term survival of rectal cancer patients following abdominoperineal and anterior resection: results of a population-based observational study.
abstract: OBJECTIVE
  The surgical management of rectal cancer is not uniform. Both abdominoperineal (APR) and anterior resection (AR) are used in potentially curative surgery but there is no definitive evidence regarding comparative survival outcomes and no randomised controlled trials. We sought to determine if any differences in survival existed between patients who received AR or APR. In addition, we sought to determine how variations in surgical management relate to the degree of specialisation and caseload of the managing consultant.
  
  
  METHODS
  A retrospective study of population-based data collected by the Northern and Yorkshire Cancer Registry and Information Service was undertaken. All patients (3521) diagnosed with rectal cancer in the former Yorkshire Regional Health Authority (population 3.6 million) between 1986 and 1994 who received either an APR or AR were included. Survival was assessed in relation to the surgical methods adopted. In addition, we determined whether the extent of specialisation of the managing consultant influenced the type of operation adopted.
  
  
  RESULTS
  A Log Rank test, stratified for sex and age, showed a statistically significant 6.7% 5-year survival advantage for patients receiving AR (p=0.0064). AR was more likely to be performed by more specialist colorectal cancer surgeons (p<0.001).
  
  
  CONCLUSIONS
  This evidence suggests that the outcomes of the two main surgical procedures used in curative surgery for rectal cancer are different and that, when possible, AR should be the operation of choice. Our results show no indication of excess risk associated with this procedure compared with APR.
authors.affiliation: Academic Unit of Epidemiology and Health Services Research, University of Leeds, Northern and Yorkshire Cancer Registry and Information Service, Arthington House, Cookridge Hospital, Leeds LS16 6QB, UK. bob.haward@nycris.leedsth.nhs.uk
authors.forename: R A
authors.initials: RA
authors.lastname: Haward
authors.forename: E
authors.initials: E
authors.lastname: Morris
authors.forename: J R T
authors.initials: JR
authors.lastname: Monson
authors.forename: C
authors.initials: C
authors.lastname: Johnston
authors.forename: D
authors.initials: D
authors.lastname: Forman
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate