title: Have French recommendations had an impact on the treatment and survival of middle and lower rectal cancer patients?
abstract: OBJECTIVE
  Compare the survival of middle and lower rectal cancer (MLRC) patients before and after the 1994 issue of rectal cancer (RC) consensus conference recommendations.
  
  
  METHODS
  Cases of MLRC noted in the Hérault department of France in 1992 (n=58) and 2000 (n=93) yielded exhaustive epidemiological, clinical-pathological and treatment data that were used to compare MLRC patient management and survival in these two periods.
  
  
  RESULTS
  Significantly more lymph nodes (≥ 8) were harvested in 2000 (≥ 8, 47%) than in 1992. In all, 45 patients (77.6%) received radiotherapy in 1992, and 74 (82%) in 2000. Chemotherapy was employed in 15 patients (25.9%) in 1992 and in 39 patients (43%) in 2000. Chemotherapy and radiotherapy, together with sphincter conservation, were dependent upon the year. Overall 5-year relative survival for rectal cancer in the Hérault department did not vary between 1992 (56%) and 2000 (56%). Independent poor prognostic factors were the same in both years: age over 75 years, lymph node involvement and metastases. Management place and year had no significant impact on prognosis.
  
  
  CONCLUSIONS
  The recommendations made have had little impact on disease management and the quality of anatomic pathology reports, and have not improved 5-year relative survival.
authors.affiliation: Registre des tumeurs de l'Hérault, centre de recherche, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France. frederic.borie@chu-nimes.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Borie
authors.forename: Andreas
authors.initials: A
authors.lastname: Kubo
authors.forename: Claire
authors.initials: C
authors.lastname: Philippe
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Bigourdan
authors.forename: Claudine
authors.initials: C
authors.lastname: Gras-Aygon
authors.forename: Brigitte
authors.initials: B
authors.lastname: Tretarre
mesh_terms: D000368:Aged; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome