Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades.
OBJECTIVE
This study aimed to investigate the outcome for stage II and III rectal cancer patients compared to stage II and III colonic cancer patients with regard to 5-year cause-specific survival (CSS), overall survival, and local and combined recurrence rates over time.


METHODS
This prospective cohort study identified 3,355 consecutive patients with adenocarcinoma of the colon or rectum and treated in our colorectal unit between 1981 and 2011, for investigation. The study was restricted to International Union Against Cancer (UICC) stages II and III. Postoperative mortality and histological incomplete resection were excluded, which left 995 patients with colonic cancer and 726 patients with rectal cancer for further analysis.


RESULTS
Five-year CSS rates improved for colonic cancer from 65.0% for patients treated between 1981 and 1986 to 88.1% for patients treated between 2007 and 2011. For rectal cancer patients, the respective 5-year CSS rates improved from 53.4% in the first observation period to 89.8% in the second one. The local recurrence rate for rectal cancer dropped from 34.2% in the years 1981-1986 to 2.1% in the years 2007-2011. In the last decade of observation, prognosis for rectal cancer was equal to that for colon cancer (CSS 88.6 vs. 86.7%, p = 0.409).


CONCLUSIONS
Survival of patients with colon and rectal cancer has continued to improve over the last three decades. After major changes in treatment strategy including introduction of total mesorectal excision and neoadjuvant (radio)chemotherapy, prognosis for stage II and III rectal cancer is at least as good as for stage II and III colonic cancer.
Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Dresden, Germany.
Joern
J
Fischer
Fischer
F
Joern
Gunter
G
Hellmich
Hellmich
H
Gunter
Thomas
T
Jackisch
Jackisch
J
Thomas
Erik
E
Puffer
Puffer
P
Erik
Jörg
J
Zimmer
Zimmer
Z
Jörg
Dorothea
D
Bleyl
Bleyl
B
Dorothea
Thomas
T
Kittner
Kittner
K
Thomas
Helmut
H
Witzigmann
Witzigmann
W
Helmut
Sigmar
S
Stelzner
Stelzner
S
Sigmar
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome