Pathogenesis of Local Recurrence after Surgical Treatment of Rectal Carcinoma

Abstract

In 499 patients with advanced rectal carcinomas (infiltration at least into the muscularis propria), a prospective study of the factors influencing the occurrence of local recurrence was undertaken. The statistical analysis involved a multivariate procedure employing logistic regression. Local recurrence was observed in 20.6% of the patients. Statistically significant factors were found to be: (a) therapy-independent, tumor-specific factors, and (b) the surgical procedure. Among the former, lymphatic spread, the depth of infiltration and localization of the primary lesion above or below the peritoneal reflection were of importance. If, in low anterior resections, the distal margin of clearance does not exceed 3 cm (measured in the fresh, unstretched, surgical specimen, and corresponding to about 5 cm in situ), the incidence rate of local recurrence increases significantly. If, however, such a margin of clearance is adhered to, the results obtained equal those seen in abdominoperineal excision of the rectum. Therefore, in low anterior resection of advanced rectal carcinomas the concept of a distal margin of clearance of more than 3 cm in the fresh, unstretched, surgical specimen should be retained.

Endosonographische Diagnostik bei präoperativer Radiotherapie des lokal fortgeschrittenen Rectumcarcinoms

“…Die prä operative Diagnostik bei fortgeschrittenen Rectumtumoren schließt neben der Histologiegewinnung zum Carcinomnachweis die Endosonographie und ggf. Darü ber hinaus lä ßt sich in der EUS der Lymphknotenstatus (N − oder N +) mit einer Genauigkeit von bis zu 78 % angeben [5]. lokaler Tumorinfiltrationstiefe (T) und tumorö s befallener Lymphknoten (N) ein.…”

“…Endosonographisch ü berschä tzte Tumorstadien kommen vor allem bei der Abgrenzung eines uT2-Tumors von einem kleinen uT3-Tumor vor [2,5,7,12]. Endosonographisch ü berschä tzte Tumorstadien kommen vor allem bei der Abgrenzung eines uT2-Tumors von einem kleinen uT3-Tumor vor [2,5,7,12].…”

“…Die gesunde Rectumwand stellt sich stets fü nfschichtig dar, wobei sich echoreiche und echoarme Schichten abwechseln [1,2,5,7,8,12]. Die Lamina muscularis propria kann der zweiten echoarmen Schicht zugeordnet werden.…”

Decision-making in Curative Rectum Carcinoma Surgery

“…This decision-making system is based not only on the abovediscussed histopathological and clinical features, but also on the experience and end results obtained in the Department of Surgery of the University of Erlangen [6,7,9,10,12,24,25,26,28,39]. Figure 5 illustrates the development of the overall and recur rence-free survival rates achieved in Erlangen from 1969 to 1987.…”