title: Longitudinal surveillance of mid- and distal rectum cancer in a subset of patients with specific histology.
abstract: OBJECTIVE
  A prospective study in 82 consecutive patients with mid- and distal rectal adenocarcinomas having specific histology and tumor stage was conducted to asses impact of curative surgery.
  
  
  METHODS
  Patients with moderately differentiated adenocarcinoma (MDAC) with or without mucinous differentiation underwent curative resection. Forty patients were in Stage B1-B2 and 42 patients were in Stage C1-C2. Surgery options were: (1) Abdominoperineal resection (APR) for tumors located within 6cm of the anal verge and (2) Tumor specific mesorectal excision (TSME) and low anterior anastomosis (LAA) for those located between 6 to 12cm from the anal verge. The primary endpoints were overall (OS) and disease-free survival (DFS).
  
  
  RESULTS
  Patients in Stage B1-B2 had a local failure rate of 15% compared with 31% of patients in stage C1-C2 (p=0.18). Satellite tumor nodule formation (STN) was observed in one patient in B group and in 13/42 (31%) of Stage C tumors. LR did not vary with mucinous differentiation. Only lymph node involvement (N1-3) (p=0.028) had an impact on locoregional recurrence and both lymph node involvement and STN formation influenced disease-free survival (p=0.008).
  
  
  CONCLUSIONS
  Preoperative precise detection of Stage C rectal adenocarcinomas is of utmost importance to facilitate the implementation of therapies for downstaging and for better local and distant control following surgery.
authors.affiliation: 3rd Department of Surgery, Izmir Teaching Hospital, Izmir, Turkey.
authors.forename: Adam
authors.initials: A
authors.lastname: Uslu
authors.forename: Hakan
authors.initials: H
authors.lastname: Postaci
authors.forename: Halit
authors.initials: H
authors.lastname: Yetis
authors.forename: Elif
authors.initials: E
authors.lastname: Selek
authors.forename: Ahmet
authors.initials: A
authors.lastname: Nart
authors.forename: Baris
authors.initials: B
authors.lastname: Corumlu
authors.forename: Baha
authors.initials: B
authors.lastname: Zengel
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aykas
authors.forename: Sait Murat
authors.initials: SM
authors.lastname: Dogan
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery