Perera, M.T.P.R.; Hewawisenthi, J.; Pathmeshwaran, A.; Deen, K.I.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA95
Academic Journal
Introduction: Rectal cancer is associated with poor overall survival at 05 years. We aimed to explore the histological features associated with poor survival in the short term, in patients having an operation for rectal cancer between March 1995 and September 2002. Patients and Methods: 84 patients (40 male, 44 female, median age 55 years, range 22-85) with rectal cancer situated (median, range) 6 cms, (1-15) from the anal verge underwent anterior resection (n = 60), abdomino-perineal resection/total reconstruction (n = 7), Hartmann operation (n = 3), restorative proctocolectomy (n = 7), and subtotal colectomy (n = 7). All specimens were evaluated by a single pathologist after haematoxylin and eosin staining of paraffin sections. The following data were obtained: TNM stage, serosal involvement by tumour, involvement of resection margins—radial, mesorectal excision, and distal resection, angioinvasion, lymphatic, and perineural involvement. The association between histology and survival was evaluated by Cox's regression and Kaplan Meier analysis. Results: The median follow up was 18 months (range 5-86 months). Overall operative mortality was 4 (4.7%). Cancer related mortality has been 26 (31%) of 84. Independent predictors of poor survival were; T stage (p = 0.028 Cox regression) and presence of metastasis (p = 0.02). Nodal involvement alone was not an independent predictor of survival (N[sub 0], p = 0.48; N[sub 3], p = 0.42). Similarly, invasion of blood vessels, lymphatics, and nerves around tumour were not independent predictors of short term survival (p = 0.64, p = 0.64, p = 0.28, respectively). Conclusion: Patients with rectal cancer were likely to have reduced short term survival in rectal tumours, which invaded beyond the submucosa, and in those with tumour involving peritoneum. The combined presence of metastasis with tumour beyond submucosa further reduced survival. Lymph node involvement by tumour reduced survival only if combined with any of the...


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