The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer.
OBJECTIVE
The aim of this study is to identify factors associated with the decision to perform an abdominoperineal resection (APR) and to assess if these factors or the surgical procedure itself is associated with circumferential resection margin (CRM) involvement, local recurrence (LR), overall survival (OS) and cancer-specific survival (CSS).


METHODS
The Swedish Rectal Cancer Trial (SRCT), TME trial, CAO/ARO/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial (PRCT) were pooled. A propensity score was calculated, which indicated the predicted probability of undergoing an APR given gender, age and distance, and used in the multivariate analyses.


RESULTS
An APR procedure was associated with an increased risk of CRM involvement [odd ratio (OR) 2.52, p<0.001], increased LR rate [hazard ratio (HR) 1.53, p=0.001] and decreased CSS rate (HR 1.31, p=0.002), whereas the propensity score was not.


CONCLUSIONS
The results suggest that the APR procedure itself is a significant predictor for non-radical resections and increased risk of LR and death due to cancer for patients with advanced rectal cancer.
den Dulk
Marcel
M
Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Putter
Hein
H
Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
Collette
Laurence
L
Department of Statistics, EORTC Headquarters, Brussels, Belgium.
Marijnen
Corrie A M
CAM
Department of Radiotherapy, NKI-AVL, Amsterdam, The Netherlands.
Folkesson
Joakim
J
Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
Bosset
Jean-Francois
JF
Department of Radiation Therapy, Besançon University Hospital, Besançon, France.
Rödel
Claus
C
Department of Radiation Therapy, University of Frankfurt, Frankfurt am Main, Germany.
Bujko
Krzysztof
K
Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
Påhlman
Lars
L
Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
van de Velde
Cornelis J H
CJH
Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl.
D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018579:Patient Selection; D010502:Perineum / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012306:Risk; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome