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Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87

Käser, S. ; Froelicher, J. ; Li, Q. ; Müller, S. ; Metzger, U. ; Castiglione, M. ; Laffer, U. ; Maurer, C.

In: Langenbeck's Archives of Surgery, 2015, vol. 400, no. 6, p. 675-682

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    Titel
    • Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87
    Autor
    • Käser, S.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Froelicher, J.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Li, Q.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Müller, S.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Metzger, U.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Castiglione, M.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Laffer, U.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    • Maurer, C.. For the Swiss Group for Clinical Cancer Research (SAKK), Effingerstrasse 40, 3008, Bern, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Langenbeck's Archives of Surgery, 2015, vol. 400, no. 6, p. 675-682. Springer Berlin Heidelberg
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:332714
    Summary
    Purpose: To investigate the prognosis of adenocarcinomas of the upper third of the rectum and the rectosigmoid-junction without radiotherapy. Methods: Patients from a multicenter randomized controlled trial from 1987-1993 on adjuvant chemotherapy for R0-resected colorectal cancers with stage I-III disease were retrospectively allocated: cancers of the lower two-thirds of the rectum (11cm or less from anal-verge, Group A, n = 205), of the upper-third of the rectum and rectosigmoid-junction (>11-20cm from anal-verge, Group B, n = 142), and of the colon (>20cm from anal-verge, Group C, n = 378). The total mesorectal excision (TME) technique had not been introduced yet. The adjuvant chemotherapy turned out to be ineffective. None of the patients received neoadjuvant or adjuvant radiotherapy. Results: The patients had a regular follow-up (median, 8.0years). The 5-year disease-free survival (DFS) rate was 0.54 (95%CI, 0.47-0.60) in Group A, 0.68 (95%CI, 0.60-0.75) in Group B, and 0.69 (95%CI, 0.64-0.74) in Group C. The 5-year overall survival (OS) rate was 0.64 (95%CI, 0.57-0.71) in Group A, 0.79 (95%CI, 0.71-0.85) in Group B, and 0.77 (95%CI, 0.73-0.81) in Group C. Compared with Group C, patients in Group A had a significantly worse OS (hazard ratio [HR] for death 2.10) and a worse DFS (HR for relapse/death 1.93), while patients in Group B had a similar OS (HR 1.12) and DFS (HR 1.07). Conclusions: Adenocarcinomas of the upper third of the rectum and the rectosigmoid-junction seem to have similar prognosis as colon cancers. Even for surgeons not familiar with the TME technique, preoperative radiotherapy may be avoided for most rectosigmoid cancers above 11cm from anal-verge.