Multicenter Study of Outcome in Relation to the Type of Resection in Rectal Cancer

Autores de IIS La Fe

• Eduardo García-Granero Ximénez

  Autor

Participantes ajenos a IIS La Fe

• Ortiz H
• Wibe A
• Ciga MA
• Kreisler E
• Roig JV
• Biondo S
• Spanish Rectal Cancer Project

Grupos

• Enfermedad Inflamatoria Intestinal

  

  Leader

  Pilar Nos Mateu

Abstract

BACKGROUND: A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer. OBJECTIVE: The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection. DESIGN: This was an observational study. SETTINGS: The study took place throughout the network of hospitals that compose the National Health Service in Spain. PATIENTS: This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed. MAIN OUTCOME MEASURES: Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed. RESULTS: After a median follow-up time of 37 months (interquartile range, 30-48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571-1.563; p = 0.825). LIMITATIONS: The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project. CONCLUSIONS: Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.

Keywords

• Abdominoperineal resection; Local recurrence; Metastases; Overall survival; Rectal cancer