Prognostic factors of local recurrence and survival after curative rectal cancer surgery: a single institution experience.

The aim of our study is to evaluate the importance of prognostic factors, both tumor-related and therapy related, and their impact on local recurrence rate of rectal carcinoma. It is also important to evaluate impact of chemoradiotherapy (CRT) on local recurrence rate and survival. We used the data of 514 patients with rectal carcinoma treated at Clinic of surgery at University Hospital Centre in Osijek, during the period from 2000 to 2007. Routine follow-up was carried out until March of 2012 or death. Median life expectancy for all patients who underwent surgery was 98 months. 47% of patients with resection without residual tumor (R0) did not develop local recurrence after median of observation of 90 months. 5-year survival rate for patients with R0 resection was 76.4%. The patients who had preoperative serum levels of carcinoembryonic antigen (CEA) within the normal range (< 5 microg/mL) had a significantly better prognosis with 5-year survival of 75.8%, than patients with elevated levels who had 5-year survival of 46.5%. Tumor stage had great influence on survival and was defined by UICC TNM (International Union against Cancer, Tumor Node Metastases) classification, 7th edition. 5-year survival rate was (93.5% for stage I, 87.4% for stage II, 58.2% for stage III, 8.1% for stage IV). Patients with low grade differentiation tumors had 5-year survival rate of 73.5%, and those with high-grade had 38.2%. We have found that preoperative CRT significantly reduces the rate of local recurrence (5.3% vs. 14.1%), but patients who were treated with preoperative CRT did not appear to benefit significantly in terms of their long-term prognosis, because there was no difference in overall survival between the patients who received preoperative radiochemotherapy and those who did not receive it (66.2% vs. 67.8%). It was found that the R-classification, anatomical extent of tumor described by the TNM classification of the UICC, tumor grade, and preoperative CEA serum level were prognostic factors that influenced survival.