The researchers investigated the impact of surgical and pathologic variables in rectal cancer outcomes.
They reported their results in the latest issue of the Journal of Clinical Oncology.
Data on 673 patients with stage II/III rectal cancer, who were enrolled onto 3 adjuvant clinical trials, was reviewed for tumor and surgical variables.
Additional information on individual institutions and operating surgeon was collected.
Variables were tested for association with 5-year local recurrence and survival, after adjustment for adjuvant treatments and other important prognostic factors.
The researchers found that 5-year local recurrence and survival rates were 16% and 59%, respectively.
Surgeons treating more than 10 study cases had lower local recurrence rates than those treating just 10 (11% vs 17%).
Free radial margins also correlated with local recurrence.
| Local recurrence rates among surgeons:|
Those treating > 10 cases: 11%
Those treating 10 cases: 17%
|Journal of Clinical Oncology|
Type of surgery, distal margins, and tumor radial spread were not found to be significant.
Tumor adherence to adjacent structures predicted local recurrence (35% vs 14%) and survival (30% vs 63%), regardless of en bloc resection.
Although T and N classification predicted survival, only N classification was found to correlate with local recurrence.
In addition, the number and percentage of positive nodes correlated with survival. However, only the percentage independently predicted local recurrence.
Several pathologic and surgical variables were reported sub-optimally.
Luca Stocchi concluded on behalf of fellow authors, "Moderate variability in outcomes among surgeons was detected in this high-risk population.
"Efforts to improve surgical results will require changes in reporting practices, to allow for more accurate assessment of the quality of surgery."