The role of clinical and pathological assessment in choosing the best therapeutic management to improve survival in rectal cancer.

The main target in rectal cancer management is an individualized therapeutic strategy, based on tumor and patient characteristics. The assessment of clinical and pathological factors is important because they represent powerful predictors of the postoperative outcome and have to be considered in the decision making regarding the appropriate surgical technique. The aim of the study was to analyze how the tumor clinical and pathological features correlate with the chosen type of surgical intervention in influencing survival of rectal cancer patients. We ran a retrospective study on 289 patients (N=289) surgically treated for rectal cancer. We analyzed the individual influence of the studied parameter on survival rate in multivariate analysis and we also grouped them in associations of parameter variations and performed a survival analysis for prognostic univariate analysis. For patients with vascular and lymphatic invasion and without perineural invasion, choosing a sphincter function preserving technique brought a better long-term outcome. The TNM stages showed the strongest statistically significant effect upon survival. Patients in T3 or T4 stage benefited best from a performed sphincter saving technique and the positive effect was even higher for those in N1 stage. Assessment of pathological parameters, in association with the type of the surgical procedure, has a strong predictive value upon survival. Sphincter function preserving techniques are followed by good long-term outcome. Accurate preoperative staging can help in choosing the best individualized therapeutic management improving the life expectancy of patients with rectal cancer.