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World Journal of Surgery

Published in:

01-11-2013

Chronological Improvement in Survival Following Rectal Cancer Surgery: A Large-Scale, Single-Center Study

Authors: Jong Lyul Lee, Chang Sik Yu, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Jin Cheon Kim

Published in: World Journal of Surgery | Issue 11/2013

Abstract

Background

Total mesorectal excision (TME) and preoperative chemoradiation therapy (PCRT) for rectal cancer are used sequentially in our center. The aim of this study was to evaluate survival of patients with stage II/III rectal cancer chronologically and to determine whether therapeutic advances associated with TME and PCRT have improved patient survival.

Methods

A retrospective review of 2,197 patients from July 1989 to December 2006 was conducted. The time period (P) for this study was divided into three groups: P1 (1989–1995), P2 (1996–2001) for TME, P3 (2002–2006) for PCRT. Cancer-specific survival (CSS), disease-free survival (DFS), and recurrences among the three periods were investigated.

Results

A total of 293 patients in P1, 836 patients in P2, and 1,068 patients in P3 were enrolled. The 5-year CSS in stages II and III was statistically different between P1/P2 and P3 (stage II, p = 0.008; stage III, p < 0.001). The 5-year DFS was significantly different between P1/P2 and P3 for stage III (p = 0.001). The local recurrence and systemic recurrence rates decreased during P3, but there was no significant difference between the three periods for stage II. For stage III, local recurrence was significantly different between the three periods (P1 vs. P2, p = 0.002; P1 vs. P3, p < 0.001; P2 vs. P3, p = 0.008).

Conclusions

We identified an improvement in survival for stage II/III rectal cancer and a decrease in local recurrence for stage III rectal cancer during P3, the most recent period. This may be due to frequent application of PCRT based on the TME.

Jemal A, Siegel R, Xu J et al (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300PubMedCrossRef

Brenner H, Bouvier AM, Foschi R et al (2012) Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study. Int J Cancer 131:1649–1658PubMedCrossRef

Korean NCIC (2012) Available at: http://www.cancer.go.kr/ncic/cics_f/03/032/index.html. Accessed April 2012 (in Korean)

Van Gijn W, Krijnen P, Lemmens VE et al (2010) Quality assurance in rectal cancer treatment in The Netherlands: a catch up compared to colon cancer treatment. Eur J Surg Oncol 36:340–344PubMedCrossRef

Chang KH, Smith MJ, McAnena OJ et al (2012) Increased use of multidisciplinary treatment modalities adds little to the outcome of rectal cancer treated by optimal total mesorectal excision. Int J Colorectal Dis 27:1275–1283PubMedCrossRef

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: The clue to pelvic recurrence? Br J Surg 69:613–616PubMedCrossRef

Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482PubMedCrossRef

Quirke P, Durdey P, Dixon MF et al (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999PubMedCrossRef

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef

10.

Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650PubMedCrossRef

11.

Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef

12.

Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRef

13.

Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130PubMedCrossRef

14.

Elferink MA, van Steenbergen LN, Krijnen P et al (2010) Marked improvements in survival of patients with rectal cancer in The Netherlands following changes in therapy, 1989–2006. Eur J Cancer 46:1421–1429PubMedCrossRef

15.

Martijn H, Voogd AC, van de Poll-Franse LV et al (2003) Improved survival of patients with rectal cancer since 1980: a population-based study. Eur J Cancer 39:2073–2079PubMedCrossRef

16.

Dahlberg M, Pahlman L, Bergstrom R et al (1998) Improved survival in patients with rectal cancer: a population-based register study. Br J Surg 85:515–520PubMedCrossRef

17.

Zaheer S, Pemberton JH, Farouk R et al (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811PubMedCrossRef

18.

Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268PubMedCrossRef

19.

Wexner SD, Rotholtz NA (2000) Surgeon influenced variables in resectional rectal cancer surgery. Dis Colon Rectum 43:1606–1627PubMedCrossRef

20.

Harmon JW, Tang DG, Gordon TA et al (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 230:404–411 (discussion 411–413)PubMedCrossRef

21.

Blomqvist P, Ekbom A, Nyren O et al (1999) Survival after rectal cancer: differences between hospital catchment areas—a nationwide study in Sweden. Gut 45:39–44PubMedCrossRef

22.

Anonymous (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer: Swedish Rectal Cancer Trial. N Engl J Med 336:980–987CrossRef

23.

Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933PubMedCrossRef

24.

Bonnetain F, Bosset JF, Gerard JP et al (2012) What is the clinical benefit of preoperative chemoradiotherapy with 5FU/leucovorin for T3-4 rectal cancer in a pooled analysis of EORTC 22921 and FFCD 9203 trials: Surrogacy in question? Eur J Cancer 48:1781–1790PubMedCrossRef

25.

Sakamoto J, Ohashi Y, Hamada C et al (2004) Efficacy of oral adjuvant therapy after resection of colorectal cancer: 5-year results from three randomized trials. J Clin Oncol 22:484–492PubMed

26.

Hofheinz RD, Wenz F, Post S et al (2012) Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 13:579–588PubMedCrossRef

Title: Chronological Improvement in Survival Following Rectal Cancer Surgery: A Large-Scale, Single-Center Study
Authors: Jong Lyul Lee
Chang Sik Yu
Chan Wook Kim
Yong Sik Yoon
Seok-Byung Lim
Jin Cheon Kim
Publication date: 01-11-2013
Publisher: Springer US
Published in: World Journal of Surgery / Issue 11/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2168-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chronological Improvement in Survival Following Rectal Cancer Surgery: A Large-Scale, Single-Center Study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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