Multicenter study of outcome in relation to the type of resection in rectal cancer

Hector Ortiz, Arne Wibe, Miguel Angel Ciga, Esther Kreisler, Eduardo Garcia-Granero, Jose Vicente Roig, Sebastiano Biondo*, Juan Lujan, Doménico Fraccalvieri, Pedro Armendáriz, Mario De Miguel, Alejandro Espí, Antonio Codina, María D. Ruiz, Eloy Espin, Rosana Palasí, Alberto Parajo, Ignasi Camps, Marta Piñol, Enrique PellicerVicent Viciano, Evelio Alonso, Miguel Pera, Teresa García, Enrique Casal, Jacinto Garcia, Marcos Rodríguez, Ángel Reina, José Errasti, José A. Múgica, José Gomez, Ricardo Rada, Mónica Orelogio, Natalia Uribe, Juan De Dios Franco, Antonio Arroyo, José Enrique Sierra, Pilar Hernandez, Jesús Paredes, Gabriel Martínez, Mauricio Garcia, Guillermo Carreño, Jesús Cifuentes, José Monzón, Olga Maseda, Daniel Huerga, Calin Pavel, Fernando Gris, Inmaculada Segura, Pablo Palma, José Gregorio Díaz, José Luis Jiménez, Francisco Pérez, Vicente Portugal, Juan C. Bernal, Félix Lluis, Luis Capitán, Nieves Cáceres, Javier Martínez, Alfredo Estévez, María Victoria Maestre, José Manuel Díaz, Mónica Reig, Antonio Amaya, José Antonio Carmona, Francisco J. Jiménez, Dídac Ribéi Serrat, Isabel Prieto, Damian Garcia, Tomas González De Francisco, Amor Turienzo, Manuel Martinez, Sergio Del Valle, Pedro Parra, Francisco Romero, Alessandro Garcea, Xavier Rodamilans O De La, Alberto Pérez, Guillermo Ais, Luis Ortiz De Zarate, Jesús Sánchez, Rafael Estevan, Albert Sueiras, Alberto Lamiquiz, Andoni Larzabal, Javier Die, Amparo Solana, Francisco Javier Blanco, Ana Ma Lage, José L. Domínguez, Paula Dujovne, Natividad Palencia, Rafael García, Raul Adell, Roberto Martínez, Ana Ma Huidobro, Carlos Pastor, Jesús Garijo, Ángel Carrillo, Ma Del Coral De La Vega, Manuel López

*Autor corresponent d’aquest treball

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23 Cites (Scopus)

Resum

BACKGROUND: A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer. OBJECTIVE: The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection. DESIGN: This was an observational study. SETTINGS: The study took place throughout the network of hospitals that compose the National Health Service in Spain. PATIENTS: This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed. MAIN OUTCOME MEASURES: Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed. RESULTS: After a median follow-up time of 37 months (interquartile range, 30-48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571- 1.563; p = 0.825). LIMITATIONS: The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project. CONCLUSIONS: Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.

Idioma originalEnglish
Pàgines (de-a)811-822
Nombre de pàgines12
RevistaDiseases of the Colon and Rectum
Volum57
Número7
DOIs
Estat de la publicacióPublicada - 2014

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