This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stocchi, L. Articles by Beart, R. Search for Related Content PubMed PubMed Citation Articles by Stocchi, L. Articles by Beart, R., Jr Social Bookmarking                            What's this?

Impact of Surgical and Pathologic Variables in Rectal Cancer: A United States Community and Cooperative Group Report

From the Division of Colon and Rectal Surgery, Cancer Center Statistics Unit, and Division of Medical Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN; University of North Carolina School of Medicine, Chapel Hill, NC; Cancer and Leukemia Group B, St Mary’s/Duluth Clinic Health System and Duluth Community Clinical Oncology Program, Duluth, MN; and University of Southern California, Los Angeles, CA.

Address reprint requests to Heidi Nelson, MD, Mayo Clinic, Division of Colon and Rectal Surgery, 200 First St SW, Rochester, MN 55905; email: nelson.heidi{at}mayo.edu

PURPOSE: Substantial and successful effort has been focused on decreasing the risk of local failure after rectal cancer surgery through the use of adjuvant therapies. Our study examined data from studies conducted by United States cooperative groups to investigate the impact of surgical and pathologic variables in rectal cancer outcomes.

PATIENTS AND METHODS: Surgical and pathologic reports from 673 patients with stage II/III rectal cancer enrolled onto three adjuvant clinical trials were reviewed for tumor and surgical variables. Additional information on individual institutions and operating surgeon was collected. Variables were tested for association with 5-year local recurrence and survival after adjustment for adjuvant treatments and other important prognostic factors.

RESULTS: Five-year local recurrence and survival rates were 16% and 59%, respectively. Surgeons treating more than 10 study cases had lower local recurrence rates than those treating 10 (11% v 17%, P = .02). Free radial margins also correlated with local recurrence (P = .01). Type of surgery, distal margins, and tumor radial spread were not significant. Tumor adherence to adjacent structures predicted local recurrence (35% v 14%, P < .001) and survival (30% v 63%, P < .001), regardless of en bloc resection. Although T and N classification predicted survival (P < .001), only N classification correlated with local recurrence. The number and percentage of positive nodes correlated with survival, but only the percentage independently predicted local recurrence. Several pathologic and surgical variables were reported suboptimally.

CONCLUSION: Moderate variability in outcomes among surgeons was detected in this high-risk population. Efforts to improve surgical results will require changes in reporting practices to allow for more accurate assessment of the quality of surgery.

Presented at the Thirty-Fifth Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, May 15-18, 1999, and available online (http://www.conference-cast.com/asco/lecture_frame.htm) and on CD-ROM.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Rutkowski, K. Bujko, M. P. Nowacki, E. Chmielik, A. Nasierowska-Guttmejer, A. Wojnar, and On Behalf of the Polish Colorectal Study Group Distal Bowel Surgical Margin Shorter than 1 cm After Preoperative Radiation for Rectal Cancer: Is It Safe? Ann. Surg. Oncol., November 1, 2008; 15(11): 3124 - 3131. [Abstract] [Full Text] [PDF]

				T. H. Kim, S.-Y. Jeong, D. H. Choi, D. Y. Kim, K. H. Jung, S. H. Moon, H. J. Chang, S.-B. Lim, H. S. Choi, and J.-G. Park Lateral Lymph Node Metastasis Is a Major Cause of Locoregional Recurrence in Rectal Cancer Treated with Preoperative Chemoradiotherapy and Curative Resection Ann. Surg. Oncol., March 1, 2008; 15(3): 729 - 737. [Abstract] [Full Text] [PDF]

				I. D. Nagtegaal and P. Quirke What Is the Role for the Circumferential Margin in the Modern Treatment of Rectal Cancer? J. Clin. Oncol., January 10, 2008; 26(2): 303 - 312. [Abstract] [Full Text] [PDF]

				C. C. Compton Optimal Pathologic Staging: Defining Stage II Disease Clin. Cancer Res., November 15, 2007; 13(22): 6862s - 6870s. [Abstract] [Full Text] [PDF]

				R. W. Beart Jr. Multidisciplinary Management of Patients with Advanced Rectal Cancer Clin. Cancer Res., November 15, 2007; 13(22): 6890s - 6893s. [Abstract] [Full Text] [PDF]

				B. M. Wolpin, J. A. Meyerhardt, H. J. Mamon, and R. J. Mayer Adjuvant Treatment of Colorectal Cancer CA Cancer J Clin, May 1, 2007; 57(3): 168 - 185. [Abstract] [Full Text] [PDF]

				R. Glynne-Jones, S. Mawdsley, T. Pearce, and M. Buyse Alternative clinical end points in rectal cancer--are we getting closer? Ann. Onc., August 1, 2006; 17(8): 1239 - 1248. [Abstract] [Full Text] [PDF]

				T. Akasu, Y. Moriya, Y. Ohashi, S. Yoshida, K. Shirao, S. Kodaira, and for the National Surgical Adjuvant Study of Colore Adjuvant Chemotherapy with Uracil-Tegafur for Pathological Stage III Rectal Cancer after Mesorectal Excision with Selective Lateral Pelvic Lymphadenectomy: A Multicenter Randomized Controlled Trial Jpn. J. Clin. Oncol., April 1, 2006; 36(4): 237 - 244. [Abstract] [Full Text] [PDF]

				I. Chau, G. Brown, D. Cunningham, D. Tait, A. Wotherspoon, A. R. Norman, N. Tebbutt, M. Hill, P. J. Ross, A. Massey, et al. Neoadjuvant Capecitabine and Oxaliplatin Followed by Synchronous Chemoradiation and Total Mesorectal Excision in Magnetic Resonance Imaging-Defined Poor-Risk Rectal Cancer J. Clin. Oncol., February 1, 2006; 24(4): 668 - 674. [Abstract] [Full Text] [PDF]

				J.-F. Bosset, G. Calais, L. Mineur, P. Maingon, L. Radosevic-Jelic, A. Daban, E. Bardet, A. Beny, A. Briffaux, and L. Collette Enhanced Tumorocidal Effect of Chemotherapy With Preoperative Radiotherapy for Rectal Cancer: Preliminary Results--EORTC 22921 J. Clin. Oncol., August 20, 2005; 23(24): 5620 - 5627. [Abstract] [Full Text] [PDF]

				J. E. Tepper and R. M. Goldberg An Embarrassment of Riches: Neoadjuvant Therapy of Rectal Cancer J. Clin. Oncol., March 1, 2005; 23(7): 1339 - 1341. [Full Text] [PDF]

				C. C. Compton and F. L. Greene The Staging of Colorectal Cancer: 2004 and Beyond CA Cancer J Clin, November 1, 2004; 54(6): 295 - 308. [Abstract] [Full Text] [PDF]

				P. W. G. Carne and H. Nelson Are We Overtreating Rectal Cancer: Time for Another Trial? Ann. Surg. Oncol., February 1, 2004; 11(2): 124 - 126. [Full Text] [PDF]

				J. A. Meyerhardt, J. E. Tepper, D. Niedzwiecki, D. R. Hollis, D. Schrag, J. Z. Ayanian, M. J. O'Connell, J. C. Weeks, R. J. Mayer, C. G. Willett, et al. Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study J. Clin. Oncol., January 1, 2004; 22(1): 166 - 174. [Abstract] [Full Text] [PDF]

				J. J. Dignam, Y. Ye, L. Colangelo, R. Smith, E. P. Mamounas, H. S. Wieand, and N. Wolmark Prognosis After Rectal Cancer in Blacks and Whites Participating in Adjuvant Therapy Randomized Trials J. Clin. Oncol., February 1, 2003; 21(3): 413 - 420. [Abstract] [Full Text] [PDF]

				J.E. Tepper, M. O'Connell, D. Niedzwiecki, D.R. Hollis, A.B. Benson III, B. Cummings, L.L. Gunderson, J.S. Macdonald, J.A. Martenson, and R.J. Mayer Adjuvant Therapy in Rectal Cancer: Analysis of Stage, Sex, and Local Control--Final Report of Intergroup 0114 J. Clin. Oncol., April 1, 2002; 20(7): 1744 - 1750. [Abstract] [Full Text] [PDF]