Rapid Communication
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 14, 2008; 14(30): 4805-4809
Published online Aug 14, 2008. doi: 10.3748/wjg.14.4805
Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection
Ze-Yu Wu, Jin Wan, Gang Zhao, Lin Peng, Jia-Lin Du, Yuan Yao, Quan-Fang Liu, Hua-Huan Lin
Ze-Yu Wu, Jin Wan, Gang Zhao, Lin Peng, Jia-Lin Du, Yuan Yao, Quan-Fang Liu, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
Hua-Huan Lin, Department of Pathology, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
Author contributions: Wu ZY and Wan J designed the research; Wu ZY, Zhao G, Peng L, Du JL, Yao Y, Liu QF and Lin HH performed research; Wu ZY analyzed the data; Wu ZY and Wan J wrote the paper.
Supported by The WST Foundation of Guangdong Province, No. 2000112736580706003
Correspondence to: Dr. Ze-Yu Wu, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China. ljhde@163.com
Telephone: +86-20-83827812-60821 Fax: +86-20-83827812
Received: April 13, 2008
Revised: June 16, 2008
Accepted: June 23, 2008
Published online: August 14, 2008
Abstract

AIM: To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection.

METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People’s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma.

RESULTS: Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients (12.5%), and was significantly associated with family history (χ2 = 3.929, P = 0.047), high CEA level (χ2 = 4.964, P = 0.026), cancerous perforation (χ2 = 8.503, P = 0.004), tumor differentiation (χ2 = 9.315, P = 0.009) and vessel cancerous emboli (χ2 = 11.879, P = 0.001). In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age (χ2 = 0.506, P = 0.477), gender (χ2 = 0.102, χ2 = 0.749), tumor diameter (χ2 = 0.421, P = 0.516), tumor infiltration (χ2 = 5.052, P = 0.168), depth of tumor invasion (χ2 = 4.588, P = 0.101), lymph node metastases (χ2 = 3.688, P = 0.055) and TNM staging system (χ2 = 3.765, P = 0.152). The local recurrence rate of middle and lower rectal carcinoma was 33.3% (4/12) in patients with positive circumferential resection margin and 6.8% (3/44) in those with negative circumferential resection margin. There was a significant difference between the two groups (χ2 = 6.061, P = 0.014). Local recurrence of rectal carcinoma occurred in 6 of 36 patients (16.7%) with mesorectal metastasis, and in 1 of 20 patients (5.0%) without mesorectal metastasis. However, there was no significant difference between the two groups (χ2 = 1.600, P = 0.206).

CONCLUSION: Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.

Keywords: Middle and lower rectal carcinoma; Local recurrence; Circumferential resection margin; Mesorectal metastasis