Top

Langenbeck's Archives of Surgery

Published in:

01-09-2005 | Current Concepts in Clinical Surgery

Survival after surgical treatment of cancer of the rectum

Authors: W. Hohenberger, B. Bittorf, T. Papadopoulos, S. Merkel

Published in: Langenbeck's Archives of Surgery | Issue 5/2005

Abstract

Background and aims

Rectal carcinoma is one of the most prevalent tumour types. Prognostic factors are of special interest to estimate prognosis of the individual patient.

Patients/methods

The data of 1,067 consecutive patients with solitary invasive rectal carcinoma, resected between 1988 and 1999 at the Department of Surgery of the University of Erlangen, were analysed. Cancer-related survival rate was calculated by univariate and multivariate analysis with respect to all relevant proven and probable prognostic factors.

Results

The R classification was found to be the parameter with the greatest influence on survival of patients with rectal carcinoma. Other tumour-related prognostic factors that influenced prognosis significantly were the anatomical extent, described by the TNM classification of the UICC, tumour grade and extramural venous invasion (EVI). In addition, the operating surgeon, a therapy-related factor, and the preoperative serum CEA level were found to influence prognosis.

Conclusion

Tumour-related prognostic factors have the greatest influence on clinical decisions with regard to choice of a therapeutic concept. The increasing survival rates after treatment of rectal carcinoma have led to a focus on postoperative quality of life. Postoperative long-term global quality of life is similar to the preoperative level. Oncological outcome is still the most important factor, and tumour recurrence leads to a strong impairment of quality of life.

Ferlay J, Bray F, Sankila R, Parkin DM (1999) EUCAN: Cancer incidence, mortality and prevalence in the European Union 1998. IARC, Lyon

Hermanek P, Wiebelt H, Staimmer D, Riedl S (1995) Prognostic factors of rectum carcinoma—experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma. Tumori 81:60–64PubMed

Hermanek P (1999) Impact of surgeon’s technique on outcome after treatment of rectal carcinoma. Dis Colon Rectum 42:559–562PubMed

Porter GA, Soskolne CL, Yakimets WW, Newman SC (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227:157–167CrossRefPubMed

Garcia-Granero E, Marti-Obiol R, Gomez-Barbadillo J, Garcia-Armengol J, Esclapez P, Espi A, Jimenez E, Millan M, Lledo S (2001) Impact of surgeon organization and specialization in rectal cancer outcome. Colorectal Dis 3:179–184CrossRefPubMed

Kapiteijn E, Putter H, van de Velde CJ (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg 89:1142–1149CrossRefPubMed

Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B (2000) Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 356:93–96CrossRefPubMed

Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734CrossRefPubMed

Hohenberger W (1997) The effect of specialisation or organisation of rectal cancer surgery. In: Soreide O, Norstein J (eds) Rectal cancer surgery. Optimisation–standardisation–documentation. Springer, Berlin Heidelberg New York, pp 353–363

10.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMed

11.

(1996) Local recurrence rate in a randomised multicentre trial of preoperative radiotherapy compared with operation alone in resectable rectal carcinoma. Swedish Rectal Cancer Trial. Eur J Surg 162:397–402PubMed

12.

Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88:1739–1757CrossRefPubMed

13.

Deutsche Krebsgesellschaft e.V. (2004) Qualitätssicherung in der Onkologie. Diagnostik und Therapie maligner Erkrankungen. Kurzgefasste Interdisziplinäre Leitlinien. W. Zuckschwerdt, München

14.

Soreide O, Norstein J, Fielding LP, Silen W (1997) International standardization and documentation of the treatment of rectal cancer. In: Soreide O, Norstein J (eds) Rectal cancer surgery. Optimisation–standardisation–documentation. Springer, Berlin Heidelberg New York, pp 405–445

15.

Wagner G, Hermanek P, Wittekind C, Sinn HP (2002) Organspezifische Tumordokumentation, 2nd edn. Empfehlungen zu Dokumentationsinhalten fuer Studien. Internetfassung (“OTD-2-Internet”). http://www.krebsgesellschaft.de

16.

Jass JR, Sobin LH (1989) Histological typing of intestinal tumours. Springer, Berlin Heidelberg New York

17.

Sobin LH, Wittekind C (2002) TNM classification of malignant tumors. Springer, Berlin Heidelberg New York

18.

Hobday TJ, Erlichman C (2001) Colorectal cancer. In: Gospodarowicz MK, Henson DE, Hutter RVP, O’Sullivan B, Sobin LH (eds) Prognostic factors in cancer. International Union against Cancer (UICC). Wiley-Liss, New York, pp 267–279

19.

Enker WE (1997) Total mesorectal excision—the new golden standard of surgery for rectal cancer. Ann Med 29:127–133PubMed

20.

Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC (2003) Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum 46:860–866PubMed

21.

Tominaga T, Sakabe T, Koyama Y, Hamano K, Yasutomi M, Takahashi T, Kodaira S, Kato T, Ogawa N (1996) Prognostic factors for patients with colon or rectal carcinoma treated with resection only. Five-year follow-up report. Cancer 78:403–408CrossRefPubMed

22.

Brenner H, Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G (2001) Long-lasting reduction of risk of colorectal cancer following screening endoscopy. Br J Cancer 85:972–976CrossRefPubMed

23.

Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357CrossRefPubMed

24.

Rodel C, Grabenbauer GG, Schick C, Papadopoulos T, Hohenberger W, Sauer R (2000) Preoperative radiation with concurrent 5-fluorouracil for locally advanced T4-primary rectal cancer. Strahlenther Onkol 176:161–167CrossRefPubMed

25.

Riedl S (1996) [Surgical therapy and prognosis of not curatively resectable rectum carcinoma. Results of a multicenter study of the Colorectal Carcinoma Study Group]. Chirurg 67:155–160

26.

McArdle CS, Hole D (1991) Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ 302:1501–1505PubMed

27.

Jatzko GR, Jagoditsch M, Lisborg PH, Denk H, Klimpfinger M, Stettner HM, Bokey EL, Chapuis PH, Dent OF, Newland RC, Koorey SG, Zelas PJ, Stewart PJ (1999) Long-term results of radical surgery for rectal cancer: multivariate analysis of prognostic factors influencing survival and local recurrence. Factors affecting survival after excision of the rectum for cancer: a multivariate analysis. Eur J Surg Oncol 25:284–291CrossRefPubMed

28.

Kockerling F, Reymond MA, Altendorf-Hofmann A, Dworak O, Hohenberger W (1998) Influence of surgery on metachronous distant metastases and survival in rectal cancer. J Clin Oncol 16:324–329PubMed

29.

Merkel S, Meyer T, Gohl J, Hohenberger W (2002) Late locoregional recurrence in rectal carcinoma. Eur J Surg Oncol 28:716–722CrossRefPubMed

30.

Sauer R (2003) Adjuvant versus neoadjuvant combined modality treatment for locally advanced rectal cancer: first results of the German rectal cancer study (CAO/ARO/AIO-94). Int J Radiat Oncol Biol Phys 57:S124–S125CrossRef

31.

Bokey EL, Chapuis PH, Dent OF, Newland RC, Koorey SG, Zelas PJ, Stewart PJ (1997) Factors affecting survival after excision of the rectum for cancer: a multivariate analysis. Dis Colon Rectum 40:3–10PubMed

32.

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMed

33.

Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK (1993) The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Qual Life Res 2:287–295PubMed

34.

Sprangers MA, te Velde A, Aaronson NK (1999) The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer 35:238–247CrossRefPubMed

35.

Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMed

36.

Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16; discussion 16–17PubMed

37.

Camilleri-Brennan J, Steele RJ (2001) Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg 88:1617–1622CrossRefPubMed

38.

Grumann MM, Noack EM, Hoffmann IA, Schlag PM (2001) Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 233:149–156CrossRefPubMed

39.

O’Leary DP, Fide CJ, Foy C, Lucarotti ME (2001) Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 88:1216–1220CrossRefPubMed

40.

Sailer M, Fuchs KH, Fein M, Thiede A (2002) Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction. Br J Surg 89:1108–1117CrossRefPubMed

41.

Hallbook O, Hass U, Wanstrom A, Sjodahl R (1997) Quality of life measurement after rectal excision for cancer. Comparison between straight and colonic J-pouch anastomosis. Scand J Gastroenterol 32:490–493PubMed

42.

Camilleri-Brennan J, Steele RJ (2002) Prospective analysis of quality of life after reversal of a defunctioning loop ileostomy. Colorectal Dis 4:167–171CrossRefPubMed

43.

Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR (2002) Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol 97:1228–1234PubMed

44.

Batignani G, Monaci I, Ficari F, Tonelli F (1991) What affects continence after anterior resection of the rectum? Dis Colon Rectum 34:329–335PubMed

45.

Bittorf B, Stadelmaier U, Gohl J, Hohenberger W, Matzel KE (2004) Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer. Eur J Surg Oncol 30:260–265CrossRefPubMed

46.

Cavaliere F, Pemberton JH, Cosimelli M, Fazio VW, Beart RW Jr (1995) Coloanal anastomosis for rectal cancer. Long-term results at the Mayo and Cleveland Clinics. Dis Colon Rectum 38:807–812PubMed

47.

Kohler A, Athanasiadis S, Ommer A, Psarakis E (2000) Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Colon Rectum 43:843–850PubMed

48.

Matzel KE, Stadelmaier U, Muehldorfer S, Hohenberger W (1997) Continence after colorectal reconstruction following resection: impact of level of anastomosis. Int J Colorectal Dis 12:82–87CrossRefPubMed

49.

Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81:1376–1378PubMed

50.

Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238:203–213CrossRefPubMed

51.

Renner K, Rosen HR, Novi G, Holbling N, Schiessel R (1999) Quality of life after surgery for rectal cancer: do we still need a permanent colostomy? Dis Colon Rectum 42:1160–1167PubMed

52.

Zieren HU, Jacobi CA, Zieren J, Muller JM (1996) [Assessment of quality of life after resection of colorectal carcinoma]. Chirurg 67:703–708; discussion 709PubMed

53.

Camilleri-Brennan J, Steele RJ (2001) The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol 27:349–353CrossRefPubMed

54.

Hamashima C (2002) Long-term quality of life of postoperative rectal cancer patients. J Gastroenterol Hepatol 17:571–576CrossRefPubMed

55.

Allal AS, Bieri S, Pelloni A, Spataro V, Anchisi S, Ambrosetti P, Sprangers MA, Kurtz JM, Gertsch P (2000) Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 82:1131–1137CrossRefPubMed

56.

Camilleri-Brennan J, Steele RJ (2002) Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Colorectal Dis 4:61–66CrossRefPubMed

57.

Jess P, Christiansen J, Bech P (2002) Quality of life after anterior resection versus abdominoperineal extirpation for rectal cancer. Scand J Gastroenterol 37:1201–1204CrossRefPubMed

58.

Guren MG, Wiig JN, Dueland S, Tveit KM, Fossa SD, Waehre H, Giercksky KE (2001) Quality of life in patients with urinary diversion after operation for locally advanced rectal cancer. Eur J Surg Oncol 27:645–651CrossRefPubMed

59.

Williams NS, Johnston D (1983) The quality of life after rectal excision for low rectal cancer. Br J Surg 70:460–462PubMed

60.

Grundmann R, Said S, Krinke S (1989) [Quality of life after rectal resection or extirpation. A comparison using different measurement parameters]. Dtsch Med Wochenschr 114:453–457PubMed

61.

Schaube J, Scharf P, Herz R (1996) [The quality of life after extirpation of the rectum for carcinoma]. Dtsch Med Wochenschr 121:153–157; discussion 158PubMed

62.

Temple LK, Wong WD, Minsky B (2003) The impact of radiation on functional outcomes in patients with rectal cancer and sphincter preservation. Semin Radiat Oncol 13:469–477PubMed

63.

Frigell A, Ottander M, Stenbeck H, Pahlman L (1990) Quality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma. Ann Chir Gynaecol 79:26–30PubMed

64.

Hohenberger W, Bittorf B (2003) Quality of life after rectal excision. Colorectal Dis 5:214–217CrossRefPubMed

65.

Ho YH, Wong J, Goh HS (1993) Level of anastomosis and anorectal manometry in predicting function following anterior resection for adenocarcinoma. Int J Colorectal Dis 8:170–174PubMed

66.

Furst A, Burghofer K, Babl-Weisbarth M, Kummel S, Tange S, Jauch KW (1998) [Functional outcome and quality of life after coloanal or colonic pouch–anal anastomosis—a prospective randomized study]. Langenbecks Arch Chir Suppl Kongressbd 115:621–624PubMed

Title: Survival after surgical treatment of cancer of the rectum
Authors: W. Hohenberger
B. Bittorf
T. Papadopoulos
S. Merkel
Publication date: 01-09-2005
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 5/2005
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-004-0497-4

At a glance: The STEP trials

Springer Medicine

Survival after surgical treatment of cancer of the rectum

Abstract

Background and aims

Patients/methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Patients/methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2005

A less invasive, selective, functional neck dissection for papillary thyroid carcinoma

9th Annual Meeting on Surgical Research / 9. Chirurgische Forschungstage 2005, 19-21 September 2005, Frankfurt am Main, Germany

Modified radical lymphadenectomy (D1.5) for T2–3 gastric cancer

Palliative management strategies of advanced gastrointestinal carcinoid neoplasms

Sentinel node metastasectomy in thin ≤1-mm melanoma

Pylorus-preserving gastrectomy in gastric cancer surgery—open and laparoscopic approaches