title: Suboptimal surgery and omission of neoadjuvant therapy for upper rectal cancer is associated with a high risk of local recurrence.
abstract: OBJECTIVE
  The aim of the present study was to estimate the risk of local recurrence in an audited cohort of patients, with a particular focus on patients with upper rectal cancer treated by partial mesorectal excision without neoadjuvant therapy.
  
  
  METHODS
  Perioperative clinical data on all patients who underwent mesorectal excision for primary adenocarcinoma of the rectum in the period from 2007 to 2010 were prospectively collected and follow-up data on oncological outcome were retrieved from patient records. Three-year actuarial local recurrence rates were estimated using Kaplan-Meier methods.
  
  
  RESULTS
  Local recurrence was diagnosed in 17 of 247 patients treated with curative intent. The 3-year actuarial local recurrence rate was 7.0% (95% CI 4.0-11.8). The risk of local recurrence was negatively associated with tumour stage (P = 0.015), an involved circumferential resection margin (P = 0.007) and tumour height (P = 0.044). The local recurrence rate at 3 years was 13.5% after partial mesorectal excision, 2.9% following total mesorectal excision and 5.7% after extralevator abdominoperineal excision (P = 0.032).
  
  
  CONCLUSIONS
  Tumour stage and an involved circumferential resection margin were the most important predictors of local recurrence. For cancer of the upper rectum, partial mesorectal excision was associated with a high risk of local recurrence.
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark; Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Bondeven
authors.forename: S
authors.initials: S
authors.lastname: Laurberg
authors.forename: R H
authors.initials: RH
authors.lastname: Hagemann-Madsen
authors.forename: B
authors.initials: B
authors.lastname: Ginnerup Pedersen
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008646:Mesocolon / Q000601:surgery; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012306:Risk; D016896:Treatment Outcome
keywords: Rectal cancer; local recurrence; neoadjuvant therapy; residual mesorectum