Abstract
BackgroundRadical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately.MethodsThis retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection.ResultsThe study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis.ConclusionFor patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.
Highlights
Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer
Data was retrieved from medical records of Chang Gung Memorial Hospital (CGMH) between 2005 and 2016, from 493 adult patients who had pT1/T2 rectal cancer; the data was collected from 279 patients with solitary, localized, resectable pT1/T2, N0 rectal adenocarcinomas with a distance from anal verge (DAV) ≤ 8 cm (Fig. 1)
Pre-treatment carcinoembryonic antigen (CEA) elevation, T2 stage, tumor distance from anal verge, close distal resection margin, lymphovascular invasion, perineural invasion, young age, male gender, ulcerative gross appearance, and anastomotic leakage have been reported for risk factors of tumor recurrence, time to recurrence, and/or the recurrence patterns [5,6,7,8,9,10]
Summary
Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. Still some of the patients experienced cancer recurrence following radical resection. Transabdominal radical resection without neoadjuvant therapy is recommended for patients with rectal cancer at clinical T1/T2 and negative N stage [1], and this sphincter-saving surgery with total mesorectal excision (TME) has been associated with high survival rates and low recurrence rate [2]. Concerns remain surrounding treatment, and though quality of life has improved, patients may still be at higher risk for disease recurrence [3, 4]. Previous studies reporting on rates of local recurrence (LR) and distant metastasis (DM) in patients with rectal cancer have not been consistent and owing to the
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