Site-specific risk factors for local recurrence after rectal cancer surgery |
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| Affiliation: | 1. APHP, Pitié-Salpêtrière Hospital, Department of Radiation Oncology, Paris, France;2. Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Department of Radiation Oncology, Paris, France;3. APHP, Tenon Hospital, Department of Medical Physics, Paris, France;4. APHP, Pitié Salpêtrière Hospital, Department of Medical Physics, Paris, France;5. Department of Radiation Oncology, Civil Colmar Hospital, Colmar, France;6. Department of Gastroenterology, Reims University Hospital, France;7. Department of Radiation Oncology, Bordeaux Nord Aquitaine Polyclinic, France;8. Department of Medical Physics, Mulhouse and South Alsace Hospital, France;9. Department of Radiation Oncology, South Lyon Hospital, France;10. Department of Radiation Oncology, Nimes University Hospital, France;11. Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France;12. Department of Radiation Oncology, ICANS, Strasbourg, France;13. Department of Radiation Oncology, Tivoli Ducos Clinic, Bordeaux, France;14. Department of Radiation Oncology, Armorican Radiation Therapy, Radiology and Oncology Center, Plérin, France;15. Department of Radiation Oncology, Montpellier-Val d’Aurelles Cancer Institute, France;p. Department of Radiation Oncology, Loire Cancer Institute Saint-Priest-en-Jarez France;q. Department of Radiation Oncology, Western Cancer Institute, Nantes, France;r. Department of Radiation Oncology, Jean Mermoz Private Hospital, Lyon, France;s. Department of Radiation Oncology, Paoli Calmettes Institute, Marseille, France;t. Department of Radiation Oncology, Lorraine Cancer Institute, Nancy, France;u. Department of Radiation Oncology, Inter-régionaL Cancer Institute (ILC) – Jean Bernard Center-Victor Hugo Clinic, Le Mans, France;v. Department of Radiation Oncology, Saint-Louis Hospital, APHP, Paris, France;w. Department of Radiation Oncology, Léon Bérard Center, Lyon, France;x. Department of Medical Oncology, Sainte-Anne Clinic, Langon, France;y. Department of Radiation Oncology, Bergonié Institute, Bordeaux, France;z. Department of Radiation Oncology, Jean Godinot Institute, Reims, France;11. Department of Radiation Oncology, Bordeaux University Hospital, France;12. INSERM 1035, University of Bordeaux, France;13. Hôpitaux Universitaires Henri Mondor, APHP, Henri Mondor Hospital, Department of Radiation Oncology, Paris, France;14. Department of Radiation Oncology, Antoine Lacassagne Center, Nice, France;15. UMR_S 938, Centre de Recherche de Saint Antoine, Paris, France;16. APHP, Tenon Hospital, Department of Radiation Oncology, Paris, France;1. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India;2. Department of Medical Physics, Tata Memorial Hospital, Mumbai, India;3. Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India;1. Radiation Oncology, Campus Bio-Medico University, Rome, Italy;2. General Surgery, Campus Bio-Medico University, Rome, Italy;3. Geriatric Surgery, Campus Bio-Medico University, Rome, Italy;4. Diagnostic Imaging, Campus Bio-Medico University, Rome, Italy;5. Radiation Oncology, University Tor Vergata, Rome, Italy;1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;2. Division of Surgery, Danderyd Hospital, Stockholm, Sweden;3. Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden;4. Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden;1. Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan;2. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan |
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| Abstract: | BackgroundQuite few studies examined risk factors for local recurrence after rectal cancer surgery with respect to local recurrence sites.MethodsLocal recurrence sites were categorized into axial, anterior, posterior, and lateral (pelvic sidewall), and axial, anterior, and posterior type were combined as the “other” type of local recurrence. Among 76 patients enrolled into our prospective randomized controlled trial to determine the indication for pelvic autonomic nerve preservation (PANP) in patients with advanced lower rectal cancer (UMIN000021353), multivariate analyses were conducted to elucidate risk factors for either lateral or the “other” type of local recurrence.ResultsUnivariate analyses showed that tumor distance from the anal verge was significantly (p = 0.017), and type of operation (sphincter preserving operation (SPO) vs. abdominoperineal resection (APR)) was marginally (p = 0.065) associated with pelvic sidewall recurrence. Multivariate analysis using these two parameters showed that tumor distance from the anal verge was significantly and independently correlated with pelvic sidewall recurrence (p = 0.017). As for the “other” type of local recurrence, univariate analyses showed that depth of tumor invasion (p = 0.011), radial margin status (p < 0.001), and adjuvant chemotherapy (p = 0.037) were significantly associated, and multivariate analysis using these three parameters revealed that depth of tumor invasion (p = 0.004) and radial margin status (p < 0.001) were significantly and independently correlated with the “other” type of local recurrence.ConclusionRisk factors for local recurrence after rectal cancer surgery were totally different with respect to the intra-pelvic recurrent sites. Site-specific probability of local recurrence can be inferred using these risk factors.Trial registration numberUMIN000021353. |
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| Keywords: | Rectal cancer Pelvic sidewall recurrence Local recurrence Multivariate analysis |
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