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Title: Abdominoperineal Resection Associated With Local Recurrence Risk for Rectal Cancer: Presented at ESSO
URL: http://www.pslgroup.com/dg/22BC82.htm
Doctor's Guide
September 11, 2008

By Shazia Qureshi

THE HAGUE, Netherlands -- September 11, 2008 -- In a pooled analysis of 5 clinical trials in patients with rectal cancer, the abdominoperineal resection procedure was associated with increased risk of local recurrence and circumferential resection margin involvement.

Lead author Marcel den Dulk, MD, Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands, called for a change in the abdominoperineal resection procedure, suggesting that "after proper imaging, in select cases, a cylindrical resection should be performed to obtain complete resection and improve local control."

He presented the research findings here on September 10 at the 14th Congress of the European Society of Surgical Oncology (ESSO).

The total number of patients in the pooled database was 5,187, and the median follow-up was 6.4 years.

The study pooled data from the European Organisation for Research and Treatment of Cancer (EORTC) 22921 trial, the Dutch Total Mesorectal Excision (TME) trial, the Swedish Rectal Cancer trial, the Polish Rectal Cancer trial, and the German Rectal Cancer Study Group's trial CAO/ARO/AIO-94.

Dr. den Dulk and his colleagues assigned each patient a propensity score that predicted the probability of undergoing an abdominoperineal resection according to the age and gender of the patient as well as the distance of the tumour from the anal margin. They then conducted multivariate analyses for the occurrence of circumferential resection margin involvement, local recurrence of the tumour, and overall survival.

Results showed that the propensity score -- but not the tumour- or patient-related factors -- was predictive of circumferential resection margin involvement and local recurrence. Anastomotic leakage was found to affect overall survival.

In addition, a more detailed analysis of patients with advanced disease in the EORTC 22921 trial showed that preoperative radiation therapy (5 doses of 5 Gy) with locally extended resection resulted in less downstaging than preoperative chemoradiotherapy. However, the chemoradiotherapy did not result in less circumferential resection margin involvement.

"These pooled data are an indication that our surgical procedure itself is the problem," said Dr. den Dulk.

[Presentation title: Focus on the Abdominoperineal Resection in a Pooled European Database Project: Time for a Surgical Change. Abstract 26]

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