Rectal carcinoma: are we making a difference?

Abstract

Evaluation of preliminary results at our institution revealed an improvement in survival of patients treated for rectal cancer from 1950-1988. A study was conducted to analyze responsible factors. A total of 335 patients with accurate staging and follow up for at least 5 years or until death were reviewed retrospectively. Of the 335 patients, 295 (88%) were treated by surgical resection, abdominal perineal resection (APR) (n=179), and anterior resections (n=105), the most common procedures. Operative mortality for patients with curable disease (n=188) was 18 per cent (n=34), which has significantly decreased from 24 per cent (n=28) (1950-1969) to 8 per cent (n=6) (1970-1988), (P < 0.01). Operative mortality for APR and anterior resection was 22 per cent (n=29) and 8 per cent (n=5), respectively. Mortality for APR decreased from 28 per cent (1950-1969) to 10 per cent (1970-1988) (P < 0.02) accounting for most of the improvement. Of the 335 patients, 142 (42%) presented with stage IV disease, which decreased from 54 per cent (n=47) (1950s) to 22 per cent (n=10) (1980s), P < 0.01. The overall 5-year survival was 19 per cent (n=64), with a corresponding increase per decade from 13 per cent (1950s) to 43 per cent (1980s), (P < 0.001). Of the remaining 188 patients, 41 had involved surgical margins and decreased 5-year survival of 8 per cent when compared to patients with clear surgical margins (37%) P < 0.01). Multifactor analysis revealed that stage of disease at presentation, involved surgical margins, and operative mortality were significant independent variables. Earlier stage at presentation and improved operative management increased the survival of patients with rectal cancer at our institution.