Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

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Abstract
Background: Mobilization of rectal cancer can be difficult if the tumour is located anteriorly and may result in a higher incidence of local recurrence. The aim of this study was to determine whether local recurrence and survival following curative resection of rectal cancer were associated with the position of the tumour. Methods: Data were drawn from a comprehensive, prospective hospital registry of all resections for rectal cancer from January 1990 to December 1998, with follow-up to December 2003. Results: The 5-year local recurrence rate was 15·9 (95 per cent confidence interval (c.i.) 11·0 to 22·8) per cent in 176 patients with tumours that had an anterior component compared with 5·8 (95 per cent c.i. 2·8 to 11·9) per cent in 132 patients with tumours without an anterior component (P = 0·009). This association persisted after adjustment for other factors linked to local recurrence (hazard ratio (HR) 2·4 (95 per cent c.i. 1·1 to 5·4)). Similarly, anterior position had a significant negative independent association with survival (HR 1·4 (95 per cent c.i. 1·0 to 2·00)). Conclusion: Anterior position is an independent negative prognostic factor for both local recurrence and survival after curative resection of rectal cancer.