Five-year treatment outcomes for stage II to III rectal cancer in a single cancer institution

Abstract

© 2014 Hong Kong College of Radiologists.Objective: This study aimed to find out the survival and recurrence rates following curative treatments for stage II and III rectal adenocarcinoma. Methods: Between I January 2002 and 31 December 2007. 344 patients with stage II or III rectal cancer treated with curative intent were retrospectively reviewed in our institution. Treatment methods, survival outcomes, and the patterns of failure were analysed. Results: Among this patient cohort, 193 patients received total mesorectal excision (TME) surgery and 146 had non-TME surgery. Of the patients, 83 underwent neoadjuvant radiotherapy or chemoradiotherapy, whereas 261 received surgery without neoadjuvant treatment. The overall survival rate and local recurrence rate of the entire group at 5 years was 66.1% and 14.4%, respectively. Patients with TME surgery had significantly lower local recurrence rate (9.7%) than those with non-TME surgery (20.1%; p = 0.01). There was a trend for superior 5-year overall survival (70.6% vs. 61.9%; p = 0.09). The 5-year disease-free survival (61.4% vs. 48.2%; p = 0.025) was significantly improved in the TME versus non-TME groups. Clear surgical margins and the use of adjuvant therapy were associated with better overall survival. Routine preoperative local staging of patients was inadequate, with only 31.7% of patients having received endorectal ultrasound or pelvic magnetic resonance imaging before operation. Conclusion: Increased adoption of TME surgery, clear surgical margins, and the use of adjuvant therapy are important factors for improving the treatment outcomes for stage II and III rectal cancer. An adequate preoperative local staging is also recommended.