title: Does rectal cancer height influence the oncological outcome?
abstract: OBJECTIVE
  The influence of the height of rectal cancer from the anal verge on the oncological outcome is controversial. This study aimed to determine the influence of the height of the tumour on the survival of patients treated in a specialized rectal cancer unit.
  
  
  METHODS
  Patients undergoing surgery for primary rectal cancer from 2006 to 2013 were identified from a prospectively maintained rectal cancer database. Those requiring total or multicompartmental pelvic exenteration were excluded. Low cancer was defined as tumour < 5 cm from the anal verge, as assessed by endoscopy and/or digital rectal examination. The primary outcome was 3-year disease-free survival (DFS).
  
  
  RESULTS
  Of 340 patients, 203 (59.7%) had low cancer. There were 302 (89%) restorative and 38 (11%) nonrestorative procedures. The rate of positive circumferential resection margin was similar for low compared with high cancer (3.4% vs 2.9%, P = 1.0) and for restorative compared with nonrestorative procedures in low cancer only (3.0% and 5.3%, P = 0.619). Low compared with high anterior resection was associated with increased anastomotic leakage (8.5% vs 2.2%, P = 0.023). Three-year DFS was similar for low and high resection (82% vs 86%, P = 0.305) and between restorative vs nonrestorative procedures in low cancer only (88% vs 77%, P = 0.215). In an adjusted model, low height did not lead to worse survival outcome (3-year DFS hazard ratio 0.54, 95% CI 0.24-1.24, P = 0.147).
  
  
  CONCLUSIONS
  With careful planning and a multidisciplinary approach, equivalent oncological outcome can be achieved for patients with rectal cancer who undergo curative surgery regardless of differences in tumour characteristics, location and operation performed.
authors: Department of Colorectal Surgery, Royal Marsden Hospital, London, UK; Division of Surgery, Imperial College London, Chelsea and Westminster Campus, London, UK.
authors: A
authors: A
authors: Bhangu
authors: S
authors: S
authors: Rasheed
authors: G
authors: G
authors: Brown
authors: D
authors: D
authors: Tait
authors: D
authors: D
authors: Cunningham
authors: P
authors: P
authors: Tekkis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D020706:Laparoscopes / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012007:Rectum / Q000473:pathology*; D015996:Survival Rate; D055815:Young Adult
keywords: Rectal cancer; abdominoperineal excision; anterior resection; low rectal cancer