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World J Gastroenterol. Jan 7, 2012; 18(1): 64-69
Published online Jan 7, 2012. doi: 10.3748/wjg.v18.i1.64
Risk factors for adverse outcome in low rectal cancer
Zhi-Hui Chen, Xin-Ming Song, Shi-Cai Chen, Xin-Xin Li, Wen-Hua Zhan, Yu-Long He, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Ming-Zhe Li, Department of Surgery II, Huangpu Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510700, Guangdong Province, China
Author contributions: Chen ZH assisted with the analysis and interpretation of the data and drafting the article; Song XM participated in designing, drafting and revising the article; Chen SC took park in the acquisition of data and drafting of the article; Li MZ helped with analyzing and interpreting the data and drafting the article; Li XX took park in analyzing the data and drafting the article; He YL assisted with designing the study and revising the article; Zhan WH helped revise the article; All authors approve the final version to be published.
Correspondence to: Yu-Long He, MD, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China. firstname.lastname@example.org
Telephone: +86-20-87755766 Fax: +86-20-87331428
Received: April 8, 2011
Revised: July 7, 2011
Accepted: July 14, 2011
Published online: January 7, 2012
AIM: To demonstrate the oncologic outcomes of low rectal cancer and to clarify the risk factors for survival, focusing particularly on the type of surgery performed.
METHODS: Data from patients with low rectal carcinomas who underwent surgery, either sphincter-preserving surgery (SPS) or abdominoperineal resection (APR), at The First Affiliated Hospital of Sun Yat-sen University in China from August 1994 to December 2005 were retrospectively analyzed.
RESULTS: Of 331 patients with low rectal cancer, 159 (48.0%) were treated with SPS. A higher incidence of positive resection margins and a higher 5-year cumulative local recurrence rate (14.7% vs 6.8%, P = 0.041) were observed in patients after APR compared to SPS. The five-year overall survival (OS) was 54.6% after APR and 66.8% after SPS (P = 0.018), and the 5-year disease-free survival (DFS) was 52.9% after APR and 65.5% after SPS (P = 0.013). In multivariate analysis, poor OS and DFS were significantly related to positive resection margins, pT3-4, and pTNM III-IV but not to the type of surgery.
CONCLUSION: Despite a higher rate of positive resection margins after APR, the type of surgery was not identified as an independent risk factor for survival.