Rectal cancer: factors influencing the development of local recurrence after radical anterior resection.

The study was designed to select criteria which influence the incidence of local recurrence after radical anterior resection for rectal cancer. Local recurrence developed in 18 patients (20%) out of 90. All patients entered a prospective clinical study for the detection of local recurrence (mean observation time: 50 months). The following criteria were evaluated retrospectively: age, sex, staging, grading, gross appearance of the tumour, lymphatic reaction, invasion of lymph- and blood vessels, perineural invasion, mucus production of the tumour and width of the distal margin of clearance (measurement in cm in the specimen immediately after resection). The incidence of local recurrence (%) depended on Dukes stage (A: 7%, B: 17%, C: 40%; p less than or equal to 0.03), grading (well differentiated: 5%, average: 20%, poorly differentiated: 55%; p less than or equal to 0.02), gross appearance (protuberant: 15%, infiltrating: 47%; p less than or equal to 0.006), lymphatic stroma reaction (yes: 10%, no: 45%; p less than or equal to 0.006), invasion of veins (yes: 75%, no: 20%; p less than or equal to 0.0002), perineural invasion (yes: 52%, no: 17%; p less than or equal to 0.001) and the margin of clearance (less than 1 cm: 52%; 1-3 cm: 10%, greater than 3 cm: 15%; p less than or equal to 0.02 Mantel, p less than or equal to 0.05 Breslow between less than 1 cm vs 1-3 cm and greater than 3 cm, respectively). Local recurrence was not related to age, sex and mucus production of the tumour. Unfavourable morphological criteria may help to define groups with a higher risk of developing local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)