Multicenter study of outcome in relation to the type of resection in rectal cancer.

BACKGROUND

A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer.

OBJECTIVE

The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection.

DESIGN

This was an observational study.

SETTINGS

The study took place throughout the network of hospitals that compose the National Health Service in Spain.

PATIENTS

This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed.

MAIN OUTCOME MEASURES

Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed.

RESULTS

After a median follow-up time of 37 months (interquartile range, 30-48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571-1.563; p = 0.825).

LIMITATIONS

The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project.

CONCLUSIONS

Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.