Total mesorectal excision for rectal cancer: difference in outcome for low and high rectal cancer.
OBJECTIVE
This prospective study was designed to assess the outcome through the first five years after the introduction of total mesorectal excision in 1993 in a Norwegian central hospital, with special regard to the difference between low (< or =6 cm from anal verge) and high (>6 cm) rectal cancers.


METHODS
A total of 140 patients (81 males; median age, 64 (range, 29-87) years) underwent surgery for rectal cancer under curative intention.


RESULTS
Local recurrence rates were 8 of 44 (18 percent) for the low cancers and 5 of 96 (5 percent) for the high, a statistically significant difference (P = 0.0014). Corresponding numbers when the R1 resections are excluded were 5 of 36 (13 percent) for the low and 4 of 92 (4 percent) for the high cancers (P = 0.002). The five-year survival after R0 resections of cancers <6 cm was significantly reduced compared with those >6 cm. The five-year overall survival for the whole material was 72 percent.


CONCLUSIONS
Surgery alone for rectal cancer can achieve overall good results, with five-year overall survival of 72 percent. The prognosis of the cancers of the lower rectum seems to be inherently different from the tumors of the higher level, both concerning local recurrence and five-year survival, suggesting different biologic behavior of the two cancers.
Faerden
Arne E
AE
Department of Surgery, Akershus University Hospital, Lørenskog, Norway. arne.ferden@ahus.no
Naimy
Nazir
N
Wiik
Pål
P
Reiertsen
Ola
O
Weyessa
Seyoum
S
Trønnes
Sigurd
S
Andersen
Solveig Norheim
SN
Bakka
Arne
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome