Peritoneal reflection involvement as a prognostic factor in rectal cancer. Long-term oncological outcomes from a prospective study.

Autores de IIS La Fe

• Eduardo Álvarez Sarrado

  Autor

• 

  Matteo Frasson

  Autor

• Jorge Sancho Muriel

  Autor

• Maria Jose Gomez Jurado

  Autor

• Hanna Barbara Cholewa

  Autor

• Vicent Primo I Romaguera

  Autor

• Mónica Millán Scheiding

  Autor

• Adela Batista Domenech

  Autor

• Polina Rudenko

  Autor

• Blas Flor Lorente

  Autor

• Eduardo García-Granero Ximénez

  Autor

• Francisco Giner Segura

  Autor

Grupos

• Cirugía digestiva y Cuidados perioperatorios

Abstract

PURPOSE: To assess the relevance of peritoneal reflection involvement in long-term oncological outcomes in patients with rectal cancer. METHODS: Prospective observational study from a specialized colorectal unit that included a consecutive series of patients undergoing mesorectal excision for rectal cancer. Peritoneal reflection (PR) involvement was evaluated on pathological examination using Shepherd's classification. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR) were assessed. RESULTS: One hundred sixty patients were included in the present analysis. Peritoneal involvement was present in 28.2% of the 85 tumors above or at the level of PR. There were no differences in OS, DFS, or LR according to tumor's height location. The 5-year OS, DFS, and LR for tumors involving PR were 58.3%, 61.7%, and 30.3%, respectively. Patients with peritoneal involvement had a higher LR rate (p = 0.02) and shorter OS (p = 0.04). Shepherd's grade 4 peritoneal involvement was an independent risk factor for OS (HR 2.9; 95% CI 1.1-9.5, p = 0.04) and LR (HR 4.2; 95% CI 1.2-16.9, p = 0.04). CONCLUSION: After rectal cancer resection, peritoneal involvement is an independent risk factor for local recurrence and poor survival.

© 2025. The Author(s).

Keywords

• Carcinomatosis; Local recurrence; Peritoneal involvement; Peritoneal reflection; Rectal cancer