title: Endoscopic obstruction in rectal cancers: survival and recurrence patterns following curative surgery.
abstract: BACKGROUND
  It is controversial whether preoperative obstruction in rectal cancers can affect prognosis or influence recurrence patterns. We investigated the association between endoscopic obstruction with survival and recurrence patterns in patients with locally advanced rectal cancers.
  
  
  METHODS
  An observational study and multivariate analysis were conducted to identify determinants of survival and to compare recurrence patterns between patients with obstructive or nonobstructive tumors after curative resection. Endoscopic obstruction was defined as a luminal obstruction of the rectum severe enough to prevent the colonoscope from passing beyond the tumor.
  
  
  RESULTS
  Cancer was obstructive in 91 patients (16.8%) and nonobstructive in 452 (83.2%). Median follow-up was 50 (range, 3-161) months. Local recurrence occurred in 17 patients (14 nonobstructed [5.4%] and 3obstructed [5.5%]; P=1.0) and systemic recurrence in 83 (62 nonobstructed [23.8%] and 21 obstructed [38.2%]; P=.042]). Endoscopic obstruction was a significant prognostic factor in stage III rectal cancers (P=.001) but not in stage II tumors. The multivariate analysis showed that endoscopic obstruction was an independent prognostic factor for overall survival, but not for disease-free survival, in patients with stage III rectal cancers. Endoscopic obstruction was associated with multiple-site systemic recurrence that was unsalvageable (salvageable surgery, 24 nonobstructed [40%] and 2 obstructed [10%]; P=.014).
  
  
  CONCLUSIONS
  Endoscopic obstruction in patients with stage III rectal cancer predicted worse overall survival and was associated with multiple-site systemic recurrence.
authors.affiliation: 1 Department of Colorectal Surgery, Korea University Ansan Hospital , Gyeonggi-do, Republic of Korea.
authors.forename: Kwang Dae
authors.initials: KD
authors.lastname: Hong
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Um
authors.forename: Woong-Bae
authors.initials: WB
authors.lastname: Ji
authors.forename: Sung Yup
authors.initials: SY
authors.lastname: Jung
authors.forename: Sanghee
authors.initials: S
authors.lastname: Kang
authors.forename: Sun Il
authors.initials: SI
authors.lastname: Lee
authors.forename: Byung-Wook
authors.initials: BW
authors.lastname: Min
authors.forename: Hong Young
authors.initials: HY
authors.lastname: Moon
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis