The surgeon as prognostic factor for local recurrence and survival in the anal sphincter preservation for mid-rectal cancer

Abstract

Background: The prognostic factors in rectal adenocarcinoma are influenced by the tumor stage. However, it is important to evaluate the role of the surgeon as part of the prognostic factors affecting local recurrence and survival rates in a group of patients with mid-rectal cancer treated with low anterior resection at a cancer referral center, and those treated at general hospitals.

Materials and methods: Eighty-two patients with mid rectal adenocarcinoma stage II and III who underwent low anterior resection from January 1980 to December 1995, were retrospectively analyzed. Forty-two patients were treated at a cancer center (Group I) and 40 patients were treated at general hospitals (Group II). Cox regression analysis for local recurrence and survival was performed.

Results: There were 42 males and 40 females with a mean age of 55.8 +/- 14.9 years. No differences were found between both groups in terms of the following: age; gender; stage; grade of differentiation; number of positive lymph nodes; infiltration of neighboring organs, and administration of adjuvant chemoradiation therapy (POST RT). However, significant differences in the number of studied lymph nodes per specimen and follow-up were found. The median follow-up for the entire group was 49 months. Local recurrence occurred in 9.5% of patients in Group I vs. 50% in Group II (p = 0.0001). The 5-year survival in Group I was 63% vs. 54% in Group II (p = 0.04). The favorable prognostic factors for local recurrence and survival were: surgical treatment at a cancer center, and no lymph node metastases.

Conclusion: The prognostic factors for local recurrence and survival depends mainly on the surgeon and on the post-surgical tumor stage.