Improved local control of rectal cancer reduces distant metastases.
OBJECTIVE
The purpose of the present national study was to determine whether improved local control has been accompanied by a change in the incidence of metastases.


METHODS
The data were from a national population-based rectal cancer registry and included all 6501 rectal cancer patients treated for cure. The study periods were 1993-1997, 1998-2000, 2001-2003 and 2004-2006.


RESULTS
Major changes in the handling of rectal cancer from the first to the last study period included an increased use of MRI from zero to 81% and the use of preoperative radiotherapy from 5% to 20%. The proportion of patients with circumferential resection margin (CRM) ≤2mm decreased from 23% to 13%. The 4-year rate of local recurrence decreased from 13% to 8% (P<0.001), the overall survival increased from 65% to 73% (P<0.001) and the incidence of distant metastases decreased from 25% to 19% (P<0.001) from the first to the last period. The risk of metastases decreased by 29% (hazard ratio 0.71, 95% CI 0.60-0.84).


CONCLUSIONS
Improved diagnostics and treatment of rectal cancer aiming at better local control and survival have resulted in a significant reduction in the incidence of distant metastases.
Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. tor.bernstein@stolav.no
T E
TE
Bernstein
B H
BH
Endreseth
P
P
Romundstad
A
A
Wibe
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000517:prevention & control*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D009664:Norway; D011300:Preoperative Care / Q000379:methods / Q000639:trends; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome