Prediction of local recurrence and survival of carcinoma of the rectum by surgical and histopathological assessment of local clearance

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Abstract
The surgeon and histopathologist were asked to assess whether clearance of the resected primary rectal tumour was complete or not. The results of each assessment were related to survival and recurrence rates. Of 478 patients entered, full information was available for 396 who were followed to death or for at least 5 years. The surgeon and pathologist agreed on the clearance in 341 of the 396 patients. The 5‐year local recurrence rate was 15 per cent in the 331 patients with complete local clearance and 62 per cent in those with incomplete clearance. There was disagreement regarding 55 patients (14 per cent) (39 pathologist ‘incomplete’/surgeon ‘complete’ 16 surgeon ‘incomplete’/pathologist ‘complete’). Local recurrence occurred later where the pathologist assessed resection to be incomplete (log rank X2 = 11·0, 1 d.f., P = 0·001). Of 321 patients without metastatic disease, the surgeon and pathologist agreed in 290 that 284 had complete and six incomplete clearance. The 5‐year survival rates were 53 and 0 per cent respectively. There was disagreement regarding 31 patients (10 per cent) (11 surgeon ‘incomplete’/pathologist ‘complete’; 20 pathologist ‘incomplete’/surgeon ‘complete’). The 5‐year survival rates were 18 and 10 per cent respectively (log rank X2 = 1·5, 1 d.f., P = 0·2). Surgical and histopathological assessments of local clearance are important in determining local recurrence and survival.