Local recurence of rectal cancer in patients with nonmetastatic disease, diagnosed in 2003 - 2005

Background : In the last decades outcomes of rectal cancer treatment are improving due to better understanding of tumor biology, neoadjuvant and adjuvant treatment and precise surgical technique, considering pathologic anatomical lines. Proportion of rectal cancer local recurrence (LR) has been substantially decreasing. Objectives of this study are, first, to find out whether two groups, with and without rectal local recurrence, are statistically important different in certain risk factors and, second, to define prognostic factors of rectal local recurrence. Methods : Total of 787 nonmetastatisc rectal cancer patients, diagnosed between 2003 and 2005, treated with surgery in all Slovenian hospitals, were enrolled retrospectively. The recurrence-free survival rates were calculated with Kaplan-Meier method. For statistical comparison of survival of two groups according to prognostic factors log-rank test was used. The adjusted hazard ratios for significant survival prognostic factors were calculated using Cox multivariate analysis. Results : Patients with LR had more tumors in the lower third of rectum (p=0,045), more abdominoperineal, Hartmann's and local excisions (p=0,000) and less radical operations (p=0,005), more of them were operated in hospitals with lesser caseload of patients (p=0,000), more often were treated only surgically (p=0,048), had more colon defects after excision of tumors (p=0,025) and had more distant disease recurrences (p=0,000). In follow up period of 5,3 years LR occurred in 13,1% and in 54% of those in 1,9 years after surgery. In the multivariate analysis, the statistically significant prognostic factors for recurrence-free survival were tumor's rectal position, regional lymph nodes status and the hospital of surgery. Conclusions : Proportion of LR is an appropriate indicator of optimal multidisciplinary rectal cancer treatment.