title: Influence of Local Recurrence and Distant Metastasis on Prognosis After Local Excision of Rectal Carcinoma.
abstract: BACKGROUND
  Influence of local recurrence (LR) on prognosis after a local excision (LE) for rectal cancer is unclear.
  
  
  METHODS
  A total of 152 patients were retrospectively assigned to one of three groups: Groups 1 and 2: complete and incomplete resection respectively, for low-risk carcinoma; group 3: high-risk carcinoma. We evaluated LR, distant metastasis (DM), overall survival, and cancer-specific survival (CSS).
  
  
  RESULTS
  LR rates were 10.4%, 43% and 29% for groups 1-3, respectively (p=0.002). In all three groups, DM incidence was low in patients without LR, but high in patients with LR (p<0.0001). Prior LR was an important risk factor for DM (hazard ratio: 14.1, 95% confidence interval=4.3-45.8, p<0.0001). DM significantly reduced CSS.
  
  
  CONCLUSIONS
  There is a strong association between LR and DM independently in the cause of LR. Avoiding LE for high-risk carcinoma and complete LE of low-risk carcinoma are essential to reduce LR and DM.
authors: Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany Junginger@uni-mainz.de.
authors: Theodor
authors: T
authors: Junginger
authors: Department of General and Abdominal Surgery, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors: Ursula
authors: U
authors: Goenner
authors: Department of General, Visceral and Vascular Surgery, Catholic Hospital, Mainz, Germany.
authors: Mirjam
authors: M
authors: Hitzler
authors: Department of Heart, Chest and Vascular Surgery, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors: Tong T
authors: TT
authors: Trinh
authors: Department of Interventional and Diagnostic Radiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors: Andre
authors: A
authors: Lollert
authors: Department of General, Visceral and Vascular Surgery, Catholic Hospital, Mainz, Germany.
authors: Achim
authors: A
authors: Heintz
authors: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors: Daniel
authors: D
authors: Wollschlaeger
authors: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors: Maria
authors: M
authors: Blettner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D000067369:Transanal Endoscopic Microsurgery / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: Early rectal cancer; distant metastasis; local excision; local recurrence; oncological outcome