Local recurrence and survival in patients with rectal cancer, diagnosed 1981-86: a community hospital-based study in the south-east Netherlands.

We carried out a population-based audit of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1981 and 1986. The study comprises 372 patients treated for rectal cancer in five community hospitals in the south-east of the Netherlands. The follow-up period was 7-12 years. We studied the medical records of these patients in the Eindhoven Cancer Registry, and by checking the endoscopical, surgical and pathological reports, we traced the following events: local recurrence, distant metastasis and (cause of) death. Curative resection was carried out in 232 of the 372 cases (62%); post-operative radiotherapy was administered to 27% of stage B2 and 50% of stage C (Astler-Coller) patients. Crude and net 5-year survival rates were 45% and 58%, respectively. Local recurrence rates were 18%, without much variation per hospital. After adjustment for age, gender, tumour site and type of surgery, local recurrence was primarily determined by tumour penetration of the muscularis propria and lymph node infiltration, the relative risks being 2.5 and 3.1, respectively (90% confidence intervals: 1.1-5.9 and 1.5-6.4). Although patients with cancer of the distal segment (0-6 cm) had shorter survival times than with proximal tumours, tumour site only weakly influenced local recurrence rates. These results confirm that the risk of recurrence for stage B2 and C patients can be reduced by more extensive surgical procedures. This study has contributed to the growing awareness of improved surgical treatment in rectal cancer.