Combined-Modality Therapy with Sphincter-Preserving Total Mesorectal Excision for Locally Advanced Rectal Cancer: Patient's Age and Long-term Outcome

download Full Article (PDF file)

Bartlomiej Szynglarewicz2, Rafal Matkowski1,2, Adam Maciejczyk3, Piotr Kasprzak4, Jozef Forgacz2, Marek Pudelko2

1) Chair and Department of Oncology, Wroclaw Medical University, Wroclaw;
2) 2nd Department of Surgical Oncology, Lower Silesian Oncology Center, Wroclaw;
3) Department of Radiation Oncology, Lower Silesian Oncology Center, Wroclaw;
4) Division of Radiology, Lower Silesian Oncology Center, Wroclaw, Poland


In rectal cancer patients anterior resection with total mesorectal excision (TME) results in good functional outcomes, optimal local control and improved survival. However, patients with locally advanced tumours still have a high risk of oncological relapse and may benefit from neo- or adjuvant therapy.

Aim. The purpose of this study was to identify the clinico-pathological features related to poor prognosis after sphincter-saving curative combined-modality therapy for rectal cancer. Material and method. Forty-eight consecutive patients with UICC stage II and III rectal carcinoma operated on with TME were studied prospectively. Fifteen patients received neoadjuvant radiotherapy and postoperative chemotherapy; for the remainder combined adjuvant chemoradiotherapy was given.

Results. Five-year cancer-specific survival rate was 49%. Patient's gender, tumour location, grade, mucinous histology, direct tumour spread, type of growth margin and lymphocytic tumour infiltration were revealed to be factors without statistical importance. Only the positive nodal status (31.6 ± 11.0 vs 61.5 ± 9.7) and the patient's advanced age (38.5 ± 9.7 vs 63.2 ± 11.4) were significantly related to decreased survival rate (p=0.038 and 0.048, respectively). In multivariate analysis both parameters independently influenced poor prognosis (p=0.045 and 0.038; Relative Risk 2.26 and 2.13; Odds Ratio 4.21 and 1.07, respectively).

Conclusions. An elderly patient's age seems to be an independent prognostic factor associated with poor survival after curative treatment for locally advanced rectal cancer even when non-cancer causes of death are excluded. Thus, for older patients adjuvant therapy should be an integral part of treatment with the careful benefit-toxicity analysis.

Key words
Rectal cancer - total mesorectal excision - anterior resection - combined-modality therapy