Local recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture

Abstract

The Large Bowel Cancer Project is a collaborative prospective study of 4228 patients with a histologically proven adenocarcinoma, of whom 2336 (55 per cent) survived a 'curative' resection. Follow-up information is available on 2220 patients (95 per cent). Subsequently, 309 (14 per cent) have developed a local recurrence confirmed by: biopsy (127; 41 per cent), clinical examination (77; 25 per cent), X-ray (15; 5 per cent), a raised CEA (2; 1 per cent), or some other method - e.g. CT scan or a confident unbiopsied laparotomy finding (88; 29 per cent). Statistically significant factors (chi2 test, P less than 0.05) associated with local recurrence are: Dukes' classification: A 4 per cent; B 13 per cent; C 18 per cent Tumour differentiation: Well 11 per cent; Moderate 14 per cent; Poor 21 per cent Obstruction: Absent 13 per cent; Present 21 per cent Perforation: Absent 13 per cent; Present 28 per cent Tumour mobility: Freely mobile 11 per cent; Others 21 per cent Operation performed (rectal and rectosigmoid tumours): Abdomino-perineal 12 per cent; Anterior resection 18 per cent; Surgeon (Consultant only): Range less than 5 per cent to greater than 20 per cent. Stratification of the above variables altered only the statistical significance pertaining to tumour differentiation (P less than 0.1, d.f. = 2). In particular, the differences between Consultant surgeons remained.

Centralised treatment, entry to trials and survival

“…Two studies of testicular cancer found that, among men receiving protocol treatment, survival rates were higher at a single centre treating very large numbers of patients (Aass et al, 1991;Harding et al, 1993) (Matthews et al, 1986;Allum et al, 1989). Two studies of colorectal cancer have shown wide variability in mortality between surgeons (Phillips et al, 1984;McArdle & Hole, 1991), but this appeared to be unrelated to the number of operations performed. Studies of survival in relation to seniority of surgeon may be especially problematic since if they were to show a higher survival rate for patients operated on by consultants then this might suggest that such operations should wherever possible be carried out by consultants, but such a policy would be irreconcilable with the fact that the junior surgeons undergoing training today are the consultants of tomorrow.…”

Cáncer De Recto; Manejo Quirúgico

“…Desde el punto de vista epidemiológico y genético tiende a considerarse al cáncer de recto como un todo junto al cáncer de colon, desde el punto de vista diagnóstico, de estadificación y terapéutico existen múltiples diferencias que justifican un análisis por El cáncer de recto, a pesar de compartir una identidad de comportamiento biológico con el cáncer de colon, siempre ha tenido peor pronóstico que este [1].…”

“…El cáncer de recto, a pesar de compartir una identidad de comportamiento biológico con el cáncer de colon, siempre ha tenido peor pronóstico que este [1].…”

A Review of Controversies in the Management of Colorectal Cancers

“…Circumferential Resection Margins (CRM): Rectal cancer has a tendency for transmural spread through the rectal wall into perirectal soft tissues contained in the mesorectum. The incidence of pelvic recurrence with conventional blunt surgery techniques for rectal cancer resection varied from 15 to 45 % [14,15]. To overcome this problem the concept of Total Mesorectal Excision (TME) to achieve adequate CRM was introduced by Heald and colleagues [16].…”