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Multicenter Study of Outcome in Relation to the Type of Resection in Rectal Cancer

Ortiz, Hector M.D., Ph.D.1; Wibe, Arne M.D., Ph.D.2,3; Ciga, Miguel Angel M.D.4; Kreisler, Esther M.D., Ph.D.5; Garcia-Granero, Eduardo M.D., Ph.D.6; Roig, Jose Vicente M.D., Ph.D.7; Biondo, Sebastiano M.D., Ph.D.5on behalf of the Spanish Rectal Cancer Project

Diseases of the Colon & Rectum: July 2014 - Volume 57 - Issue 7 - p 811–822
doi: 10.1097/DCR.0000000000000026
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer.

OBJECTIVE: The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection.

DESIGN: This was an observational study.

SETTINGS: The study took place throughout the network of hospitals that compose the National Health Service in Spain.

PATIENTS: This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed.

MAIN OUTCOME MEASURES: Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed.

RESULTS: After a median follow-up time of 37 months (interquartile range, 30–48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571–1.563; p = 0.825).

LIMITATIONS: The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project.

CONCLUSIONS: Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.

1Department of Surgery, Public University of Navarra, Pamplona, Spain

2Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

3Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

4Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain

5Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain

6Department of Surgery, Colorectal Unit, Hospital la Fe, Universidad de Valencia, Valencia, Spain

7Department of Surgery, Hospital General Universitario, Valencia, Spain

Funding/Support: This work was support by grants from the Ministry of Health, Social Services and Equality of Spain (FIS number PI11/00010) and the health authorities of the government of Navarra, Spain (20/11).

Financial Disclosure: None reported.

Correspondence: Sebastiano Biondo, M.D., Ph.D., Bellvitge University Hospital, Department of General and Digestive Surgery, c/o Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907 Barcelona, Spain. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons