Survival and disease-free survival following total mesorectal excision for local advanced rectal cancer

ACKGROUND This study reviewed the results of surgery for distal rectal cancer (tumour within 12 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. METHODS Seven hundred and eleven patients who had undergone elective curative surgical resection of rectal cancer within 12 cm of the anal verge were included. The demographic, operative and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures. RESULTS The overall operative mortality rate was nil, and the morbidity 24%. With a mean follow-up of 90 months (range: 9-196 months), local recurrence occurred in 57 of the patients, with only 14 cases performed in the last 7 years (24%; p<0.0001). There was an increased use of preoperative radiotherapy during the recent period (30% of the patients (1994-2003 vs 74% (2004-2014) p<0.0001). The 3-, 5- and 10 year actuarial local recurrence rates were 9%, 11%, and 14 % respectively for the whole group. Abdomino-perineal resection (APR) was necessary in 94/711 (13%) of the patients, with a very low local recurrence rate in this subgroup (6% at 3 years). On univariate analysis distal surgical margin <1 cm was significantly associated with increased recurrence, but only stage was a significant prognosticator of cancer-specific survival (p=0.0001). CONCLUSIONS A multidisciplinary approach to rectal cancer reduced the APR operation in the period 2004-2014. Distal surgical margin influenced local recurrence rates, and only initial tumour stage was associated with long-term survival.