Volume 6, Issue 6, December 2018, Page: 167-172
Quantitative Assessment of Prognosticators for Rectal Cancer’s Local Recurrence and Distant Metastases
Haytham Abudeeb, Department of Surgery, Hairmyres Hospital, East Kilbride, UK; Department of Surgery, Royal Blackburn Hospital, Blackburn, UK
Ajogwu Ugwu, Department of Surgery, Monklands Hospital, Monkland, UK
Lucy Campbell, Department of Surgery, Hairmyres Hospital, East Kilbride, UK
Arijit Mukherjee, Department of Surgery, Hairmyres Hospital, East Kilbride, UK
Received: Oct. 30, 2018;       Accepted: Nov. 12, 2018;       Published: Dec. 19, 2018
DOI: 10.11648/j.js.20180606.15      View  48      Downloads  23
Rectal cancer treatment outcome has improved considerably in the TME era often with the use neoadjuvant chemoradiotherapy. However, the risk of local recurrence/distant metastases could be as high as 10%. We have designed a retrospective cohort study to assess risk factors associated with local recurrence/distant metastasis after primary curative rectal resection. Our analysis of the colorectal database in a district general hospital involved review of 131 patients who had a curative resection between 2007 and 2013. 22 patients of the 131 had local recurrence/distant metastases. We reviewed the risk factors as gender, neoadjuvant chemoradiotherapy, type of operation, anastomotic leak, tumour differentiation, EMVI, CRM and Dukes C and performed a quantitative assessment. Looking at risk factors, the presence of EMVI was found to have a statistically significant association with recurrence and distant metastases (p=0.0006) followed by poor differentiation (p= 0.038) and Dukes C (p=0.045) while CRM involvement (p=0.054), Neoadjuvant chemoradiotherapy (p=0.657), type of resection (p=0.740), Anastomotic leak (p=0.761) and gender (p=0.901) shown no obvious statistical association with recurrence or distant metastases A larger multi-centre study may help in validating our observation.
Distant Metastases, Local Recurrence, Rectal Cancer, Risk Factors
To cite this article
Haytham Abudeeb, Ajogwu Ugwu, Lucy Campbell, Arijit Mukherjee, Quantitative Assessment of Prognosticators for Rectal Cancer’s Local Recurrence and Distant Metastases, Journal of Surgery. Vol. 6, No. 6, 2018, pp. 167-172. doi: 10.11648/j.js.20180606.15
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cancer registration statistics, England: 2016, Office of National Statistics.
Cancer in Wales, Welsh Cancer Intelligence & Surveillance Unit, Public Health Wales NHS Trust February 2017.
Scottish Cancer Registry.
American Cancer Society. Cancer Facts & Figures 2018. Atlanta, Ga: American Cancer Society, 2018.
Macfarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. The Lancet, Feb 1993, 341: 457-460.
Heald RJ, Moran BJ, Ryall RD, Sexton R, Macfarlane JK. Rectal Cancer: The Basingstoke Experience of Total Mesorectal Excision, 1978-97. ARCH Surg 1998, 133: 894-899.
Chau I, Brown G, Cunningham D, Tait W, Wotherspoon A, Norman Ar et al. Neoadjuvant Capecitabine and Oxilaplatin Followed by Synchronous Chemoradiation and Total Mesorectal Excision in Magnetic Resonance Imaging-Defined Poor-Risk Rectal Cancer. J Clinical Oncology 2006, 24(4): 668-674.
Van Gijn W, Marijnen CA, Nagtegaal ID, Meershoek-klein Kranenbarg E, Putter H, Wiggers T et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised control TME trial. Lancet Oncol 2011, 12: 575-582.
Heald RJ, Ryall RD. Recurrence and Survival after Total Mesorectal Excision for Rectal Cancer. The Lancet 1986, 1479-1482.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery- the clue to pelvic recurrence? Br. J. Surg 1982, 69: 613-616.
Siddiqui MRS, Simillis C, Hunter C, Chand M, Bhoday J, Garant A, Vuong T, Artho G, Rasheed S, Tekkis P, Abulafi AM, Brown G. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases, Br J Cancer. 2017 Jun 6, 116(12): 1513-1519. doi: 10.1038/bjc.2017.99. Epub 2017 Apr 27.
Chand M, Swift RI, Tekkis PP, Chau I, Brown G. Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer. British Journal of Cancer. 2014, 110(1): 19-25. doi:10.1038/bjc.2013.603.
Chand M, Rasheed S, Heald R, Swift I, West N, Rao S, Tekkis P, Brown G. Adjuvant chemotherapy may improve disease-free survival in patients with mrEMVI-positive rectal cancer following chemoradiation, Colorectal Dis. 2017 Jun, 19(6): 537-543. doi: 10.1111/codi.13535.
Rory F. Kokelaar, Huw G. Jones, Jeremy Williamson, Namor Williams, A. Paul Griffiths, John Beynon, Gareth J. Jenkins & Dean A. Harris (2018) DNA hypermethylation as a predictor of extramural vascular invasion (EMVI) in rectal cancer, Cancer Biology & Therapy, 19:3, 214.
Dresen RC, Peters EE, Rutten HJ, Nieuwenhuijzen GA, Demeyere TA, Van Den Brule AJ et al. Local Recurrence in Rectal Cancer can be Predicted by Histopathological Factors. EJSO 2009, 35: 1071-1077.
Das P, Skibber JM, Rodriguez-bigas MA, Feig BW, Chang GJ, Hoff PM et al. Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol 2006, 29(3): 219-224.
Pilipshen SJ, Heilwell M, Quan SH, Sternberg SS, Enker WE. Patterns of Pelvic Recurrence Following Definitive Resections for Rectal Cancer. Cancer 1984, 53: 1354-1362.
Nagtegaal ID, Quirke P. What is the Role for Circumferential Margin in the Modern Treatment of Rectal Cancer? J Clin Oncology 2008, 26(2): 303-312.
Nagtegaal ID, Van De Velde CJ, Marijnen CA, Van Krieken Jh, Quirke P. Low Rectal Cancer: A Call for Change of Approach in Abdominoperineal Resection. J Clin Oncol 2005, 23(36): 9257-64.
Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al. Role of Circumferential Margin Involvement in the Local Recurrence of Rectal Cancer. J Clin Oncol 1994, 344: 707-711.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005, 365: 1718–1726.
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007, 25: 3061–3068.
Iris D. Nagtegaal, Cornelius J. H. van de Velde, Corrie A. M. Marijnen, Jan H. J. M. van Krieken, Philip Quirke. Low Rectal Cancer: A Call for a Change of Approach in Abdominoperineal Resection. Journal of Clinical Oncology 23, no. 36 (December 20, 2005) 9257-9264.
Wilkins S1, Haydon A, Porter I, Oliva K, Staples M, Carne P, McMurrick P, Bell S. Complete Pathological Response After Neoadjuvant Long-Course Chemoradiotherapy for Rectal Cancer and Its Relationship to the Degree of T3 Mesorectal Invasion. Dis Colon Rectum. 2016 May, 59(5): 361-8.
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