Oncological results of extended resection for locally advanced rectal cancer: the value of postirradiation MRI in predicting local recurrence.
OBJECTIVE
The primary purpose of this study was to analyse the overall survival and local recurrence rate after extended resection of locally advanced rectal cancer. The second aim was to determine the ability of the response to radiological irradiation to predict R0 resection.


METHODS
A retrospective study was performed of 94 consecutive patients with locally advanced rectal cancer operated on at the Helsinki University Hospital, Helsinki, Finland between 2005 and 2013. Data were collected from patient records. All patients were treated with an en bloc resection. Sixty-two patients received preoperative long-term chemoradiotherapy.


RESULTS
The 30-day mortality was 3.2%. Local recurrence occurred in 10 (10.6%) patients. The cumulative 1-, 3- and 5-year overall survival to each year was 89.4%, 68.3% and 51.8%. The most important prognostic factor for both local recurrence (P = 0.006) and survival (P = 0.003) was an R0 resection. A poor or no response seen on posttreatment MRI predicted local recurrence (P = 0.045) and decreased disease-free survival in patients treated curatively (P = 0.052). The histological tumour regression grade was not associated with local recurrence or survival.


CONCLUSIONS
Multivisceral resection offers a 5-year survival of over 50% and local control of advanced rectal cancer in nearly 90% of carefully selected patients.
Colorectal Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki, Finland.|Department of Medicine, University of Helsinki, Helsinki, Finland.
M
M
Räsänen
Department of Pathology, Research Programs Unit and HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
A
A
Ristimäki
HUS Medical Imaging Centre, Meilahti Hospital, Helsinki University Hospital, Helsinki, Finland.
R
R
Savolainen
Colorectal Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki, Finland.|Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland.
L
L
Renkonen-Sinisalo
Colorectal Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki, Finland.
A
A
Lepistö
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D003082:Colectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005387:Finland; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
Locally advanced rectal cancer; histological tumour regression; long-course chemoradiotherapy; multivisceral resection; posttreatment MRI