Influence of Local Recurrence and Distant Metastasis on Prognosis After Local Excision of Rectal Carcinoma

Anticancer Res. 2016 Feb;36(2):763-8.

Abstract

Background: Influence of local recurrence (LR) on prognosis after a local excision (LE) for rectal cancer is unclear.

Patients and methods: A total of 152 patients were retrospectively assigned to one of three groups: Groups 1 and 2: complete and incomplete resection respectively, for low-risk carcinoma; group 3: high-risk carcinoma. We evaluated LR, distant metastasis (DM), overall survival, and cancer-specific survival (CSS).

Results: LR rates were 10.4%, 43% and 29% for groups 1-3, respectively (p=0.002). In all three groups, DM incidence was low in patients without LR, but high in patients with LR (p<0.0001). Prior LR was an important risk factor for DM (hazard ratio: 14.1, 95% confidence interval=4.3-45.8, p<0.0001). DM significantly reduced CSS.

Conclusion: There is a strong association between LR and DM independently in the cause of LR. Avoiding LE for high-risk carcinoma and complete LE of low-risk carcinoma are essential to reduce LR and DM.

Keywords: Early rectal cancer; distant metastasis; local excision; local recurrence; oncological outcome.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma / mortality
  • Carcinoma / secondary
  • Carcinoma / surgery*
  • Disease Progression
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local*
  • Neoplasm, Residual
  • Proportional Hazards Models
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / surgery*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Transanal Endoscopic Microsurgery* / adverse effects
  • Transanal Endoscopic Microsurgery* / mortality
  • Treatment Outcome