Lokalna ponovitev bolezni pri bolnikih, operiranih zaradi nemetastatskega raka danke, zbolelih v obdobju 2003-2005
Local recurence of rectal cancer in patients with nonmetastatic disease, diagnosed in 2003-2005

slovenian

2015

volume 84, issue 4

hospitals   prognostic factors   rectal cancer   surgery

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Background: In the last decades, outcomes of rectal cancer treatment have been improving due to better understanding of tumor biology, neoadjuvant and adjuvant treatment and precise surgical technique, considering pathologic anatomical lines. The proportion of rectal cancer local recurrence (LR) has been substantially decreasing. Objectives of this study are primarily to find out whether there are statistically important differences between the two groups of rectal cancer patients, i.e. those with and without rectal local recurrence, in terms of certain risk factors, and secondly, to define prognostic factors of rectal local recurrence. Methods: A total of 787 nonmetastatic rectal cancer patients, diagnosed between 2003 and 2005, treated by surgery in all Slovenian hospitals, were enrolled retrospectively. The recurrence-free survival rates were calculated with Kaplan-Meier method. Log-rank test was used for statistical comparison of survival of two groups according to prognostic factors. The adjusted hazard ratios for significant prognostic factors of survival were calculated using Cox multivariate analysis. Results: Patients with LR had more tumors in the lower third of the rectum (p = 0.045), more abdominoperineal, Hartmann%s and local excisions (p = 0.000) and less radical operations (p = 0.005), more of them were operated on in hospitals with lesser caseload of patients (p = 0.000), more often were treated only surgically (p = 0.048), had more colon defects after tumor excision (p = 0.025) and had more distant disease recurrences (p = 0.000). In a follow-up period of 5.3 years, LR occurred in 13.1 % and in 54 % of those within 1.9 years after surgery. In the multivariate analysis, the statistically significant prognostic factors for recurrence-free survival were tumor%s rectal position, regional lymph node status and the hospital of surgery. Conclusions: The proportion of LR is an appropriate indicator of optimal multidisciplinary rectal cancer treatment.

26.11.2015