Abstract
Purpose
The aim of this study is to identify factors associated with the decision to perform
an abdominoperineal resection (APR) and to assess if these factors or the surgical
procedure itself is associated with circumferential resection margin (CRM) involvement,
local recurrence (LR), overall survival (OS) and cancer-specific survival (CSS).
Patients and methods
The Swedish Rectal Cancer Trial (SRCT), TME trial, CAO/ARO/AIO-94 trial, EORTC 22921
trial and Polish Rectal Cancer Trial (PRCT) were pooled. A propensity score was calculated,
which indicated the predicted probability of undergoing an APR given gender, age and
distance, and used in the multivariate analyses.
Results
An APR procedure was associated with an increased risk of CRM involvement [odd ratio
(OR) 2.52, p < 0.001], increased LR rate [hazard ratio (HR) 1.53, p = 0.001] and decreased CSS rate (HR 1.31, p = 0.002), whereas the propensity score was not.
Conclusion
The results suggest that the APR procedure itself is a significant predictor for non-radical
resections and increased risk of LR and death due to cancer for patients with advanced
rectal cancer.
Keywords
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Article info
Publication history
Published online: January 07, 2009
Accepted:
November 20,
2008
Received in revised form:
November 20,
2008
Received:
October 14,
2008
Footnotes
☆Presented at the European Cancer Conference (ECCO) 2007, Barcelona, Spain: M. den Dulk, H. Putter, L. Collette, C.A.M. Marijnen, L. Påhlman, K. Bujko, C. Rödel, J.F. Bosset and C.J.H. van de Velde. Abdominoperineal resection and not distance, gender or age associated with circumferential resection margin involvement in a pooled analysis of five large European randomised clinical trials on rectal cancer (n = 5187). Eur J Cancer 2007;Supplements 5(4):237 and at the European Society of Surgical Oncology Conference (ESSO) 2008, the Hague, The Netherlands: M. den Dulk, H. Putter, L. Collette, C.A.M. Marijnen, J. Folkesson, J.F. Bosset, C. Rödel, K. Bujko, L. Påhlman and C.J.H. van de Velde. Focus on the abdominoperineal resection in a pooled European database project: time for a surgical change. Eur J Surg Oncol 2008;34(9):990 (abstract 26).
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
