Original Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Aug 27, 2011; 3(8): 113-118
Published online Aug 27, 2011. doi: 10.4240/wjgs.v3.i8.113
Proximal and distal rectal cancers differ in curative resectability and local recurrence
Wasantha Wijenayake, Mahendra Perera, Jayantha Balawardena, Raeed Deen, S Ruwan Wijesuriya, Sumudu K Kumarage, Kemal I Deen
Wasantha Wijenayake, Department of Surgery, National Hospital, Colombo, Sri Lanka
Mahendra Perera, Jayantha Balawardena, Department of Oncology, National Cancer Institute, Maharagama, Sri Lanka
Raeed Deen, S Ruwan Wijesuriya, Sumudu K Kumarage, Kemal I Deen, Department of Surgery, University of Kelaniya Medical School, Ragama, Sri Lanka
Author contributions: Wijenayake W was responsible for the concept and design, data acquisition, data analysis of this paper, and wrote, approved the final version of the manuscript; Perera M, Balawardena J and Wijesuriya SR were responsible for the concept, revised draft and approved the final version of the paper; Deen R was responsible for the concept, data entry, data acquisition and analysis of this paper and approved the final version of the manuscript; Kumarage SK was responsible for the revised draft, approved final version of this manuscript; Deen KI was responsible for the concept and design, data analysis and interpretation of this paper, and revised several drafts, approved final version of the manuscript.
Correspondence to: Kemal I Deen, MS, MD, FRCS, Professor, Department of Surgery, University of Kelaniya Medical School, PO Box 6, Talagolla Road, Ragama, Sri Lanka. radihan@mail.ewisl.net
Telephone: +94-1-2737702 Fax: +94-1-2737702
Received: March 5, 2011
Revised: August 10, 2011
Accepted: August 16, 2011
Published online: August 27, 2011
Abstract

AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge).

METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum - those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without pre-operative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour- free margins, resection with a tumour-free circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate.

RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection.

CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.

Keywords: Rectal cancer; Pre-operative chemoradiation; Inter-sphincteric resection; Local recurrence; Survival