Risk factors for tumour present in a circumferential line of resection after excision of rectal cancer.
BACKGROUND
Transected tumour in a circumferential line of resection after excision of rectal cancer carries a high likelihood of local recurrence. The aim of this study was to identify independent risk factors for transected tumour and to examine their temporal variability.


METHODS
Data were drawn from a comprehensive, prospective hospital registry of all resections for rectal cancer from January 1971 to July 2004. Transected tumour was defined as tumour present histologically in a line of resection and was assessed in all specimens.


RESULTS
Transection occurred in 129 of 1613 patients (8.0 (95 per cent confidence interval 6.7 to 9.4) per cent). The following variables were independently associated with transected tumour: tumour perforation, a non-restorative operation, tumour adherence, non-standardized operative technique, preoperative radiotherapy, male sex, histological involvement of an adjacent organ or tissue, high-grade tumour and venous invasion. The mean number of risk factors per patient per year and the annual percentage of patients with transection varied distinctly over the history of the database.


CONCLUSIONS
The varying prevalence of risk factors, both within and between hospitals and patient series, should be taken into account if the rate of transection is to be regarded as an index of the quality of surgery.
Chapuis
P H
PH
Department of Colorectal Surgery, Concord Hospital and the University of Sydney, Concord Hospital, Sydney, New South Wales 2139, Australia.
Lin
B P C
BP
Chan
C
C
Dent
O F
OF
Bokey
E L
EL
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control; D018365:Neoplasm, Residual; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome