title: Long-term survival and recurrence outcomes following surgery for distal rectal cancer.
abstract: BACKGROUND
  Treatment of distal rectal cancer remains clinically challenging and includes proctectomy and coloanal anastomosis (CAA) or abdominoperineal resection (APR). The purpose of this study is to evaluate operative and pathologic factors associated with long-term survival and local recurrence outcomes in patients treated for distal rectal cancer.
  
  
  METHODS
  A retrospective consecutive cohort study of 304 patients treated for distal rectal cancer with radical resection from 1993 to 2003 was performed. Patients were grouped by procedure (CAA or APR). Demographic, pathologic, recurrence, and survival data were analyzed utilizing chi-square analysis for comparison of proportions. Survival analysis was performed using Kaplan-Meier method and log-rank test for univariate and Cox regression for multivariate comparison.
  
  
  RESULTS
  The median tumor distance from the anal verge was 2 cm [interquartile range (IQR) 0.5-4 cm]. Margins were negative in all but four patients (one distal, 0.3%; three radial, 1%). The 5-year overall survival rate was 82% (88.6% stage pI, 80.5% stage pII, 67.9% stage pIII). Older age, advanced pathologic stage, presence of lymphovascular or perineural invasion, earlier treatment period, and APR surgery type were associated with worse survival on multivariate analysis. The 5-year local recurrence rate was 5.3% after CAA and 7.9% after APR (p = 0.33).
  
  
  CONCLUSIONS
  Low rates of local recurrence and good overall survival can be achieved after treatment of distal rectal cancer with stage-appropriate chemoradiation and proctectomy with CAA or APR. Sphincter preservation can be achieved even with distal margins less than 2 cm.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Silberfein
authors.forename: Kiran M
authors.initials: KM
authors.lastname: Kattepogu
authors.forename: Chung-Yuan
authors.initials: CY
authors.lastname: Hu
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.forename: Barry
authors.initials: B
authors.lastname: Feig
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Christopher
authors.initials: C
authors.lastname: Crane
authors.forename: Scott
authors.initials: S
authors.lastname: Kopetz
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome