Pattern of recurrence in rectal carcinoma: implications for the design of (future) studies on adjuvant therapy

• Published in: International journal of colorectal disease Vol. 8; no. 3; pp. 142 - 147
• Main Authors: BARRAS, J.-P, BACHMANN, R, AEBERHARD, P
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-09-1993; Berlin
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adenocarcinoma, Mucinous - mortality; Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Aged; Biological and medical sciences; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Neoplasm Metastasis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - mortality; Neoplasm Staging; Prognosis; Prospective Studies; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectal Neoplasms - therapy; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Tumors; Human; Relapse; Carcinoma; Prognosis; Treatment; Surgery; Rectum; Digestive diseases; Malignant tumor; Survival; Anorectal disease
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/BF00341187

255 patients who underwent potentially curative surgical treatment for rectal carcinoma at the Cantonal Hospital Aarau from 1981 to 1989 have been followed up and the results analysed for overall survival and the timing and occurrence of local and distant recurrence in relation to the initial tumor stage. The patients had received standard surgical treatment for rectal carcinoma with the exception of 28 patients who had been randomized to the treatment arm of SAKK protocol 40/81 and were given perioperative adjuvant portal chemotherapy. 10 patients with large fixed tumors had preoperative radiation therapy. In UICC stage I most patients were cured by surgery alone, local recurrence as rare, and distant metastases appear in about 10% of pT2. cases. In stage II about one fifth of the patients developed a recurrence with one third of them having only local recurrence, and two thirds having either combined local and distant recurrence or distant recurrence alone. The small subgroup of pT4 pN0 had a very poor prognosis with early occurrence of distant metastases. In stage III the actuarial five-year survival was 25%, 60% of stage III cases had pN1 nodal disease. No patient with pN2-3 disease was alive after five years follow-up. The overall risk of distant metastases in stage III was 64%. Local recurrence rate was highly dependent on the pT-stage.