Rectal cancer: factors influencing the development of local recurrence after radical anterior resection

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Abstract
The study was designed to select criteria which influence the incidence of local recurrence after radical anterior resection for rectal cancer. Local recurrence developed in 18 patients (20%) out of 90. All patients entered a prospective clinical study for the detection of local recurrence (mean observation time: 50 months). The following criteria were evaluated retrospectively: age, sex, staging, grading, gross appearance of the tumour, lymphatic reaction, invasion of lymph- and blood vessels, perineural invasion, mucus production of the tumour and width of the distal margin of clearance (measurement in cm in the specimen immediately after resection). The incidence of local recurrence (%) depended on Dukes stage (A: 7%, B: 17%, C: 40%;p≤0.03), grading (well differentiated: 5%, average: 20%, poorly differentiated: 55%;p≤0.02), gross appearance (protuberant: 15%, infiltrating: 47%;p≤0.006), lymphatic stroma reaction (yes: 10%, no: 45%;p≤0.006), invasion of veins (yes: 75%, no: 20%;p≤0.0002), perineural invasion (yes: 52%, no: 17%;p≤0.001) and the margin of clearance ( 3 cm: 15%;p≤0.02 Mantel,p≤0.05 Breslow between 3 cm, respectively). Local recurrence was not related to age, sex and mucus production of the tumour. Unfavourable morphological criteria may help to define groups with a higher risk of developing local recurrence. A tumour-free margin exceeding at least 1 cm appears necessary to reduce the rate of local recurrence. Dr. Wolfgang Feil