Improved local control of rectal cancer reduces distant metastases.

AIM

The purpose of the present national study was to determine whether improved local control has been accompanied by a change in the incidence of metastases.

METHOD

The data were from a national population-based rectal cancer registry and included all 6501 rectal cancer patients treated for cure. The study periods were 1993-1997, 1998-2000, 2001-2003 and 2004-2006.

RESULTS

Major changes in the handling of rectal cancer from the first to the last study period included an increased use of MRI from zero to 81% and the use of preoperative radiotherapy from 5% to 20%. The proportion of patients with circumferential resection margin (CRM) ≤2mm decreased from 23% to 13%. The 4-year rate of local recurrence decreased from 13% to 8% (P<0.001), the overall survival increased from 65% to 73% (P<0.001) and the incidence of distant metastases decreased from 25% to 19% (P<0.001) from the first to the last period. The risk of metastases decreased by 29% (hazard ratio 0.71, 95% CI 0.60-0.84).

CONCLUSION

Improved diagnostics and treatment of rectal cancer aiming at better local control and survival have resulted in a significant reduction in the incidence of distant metastases.