Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease

• Published in: Acta chirurgica belgica Vol. 124; no. 3; p. 208
• Main Authors: Mattart, L, Magotteaux, P, Blétard, N, Brescia, L, Debergh, N, De Meester, C, Demolin, G, Dister, F, Focan, C, Francart, D, Godin, S, Houbiers, G, Jehaes, C, Jehaes, F, Namur, G, Monami, B, Verdin, V, Weerts, J, Witvrouw, N, Markiewicz, S
• Format: Journal Article
• Language: English
• Published: England 01.06.2024
• Subjects: Adult; Aged; Aged, 80 and over; Anastomotic Leak - epidemiology; Disease-Free Survival; Female; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Patient Readmission - statistics & numerical data; Proctectomy; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; mortality; Rectal adenocarcinoma surgery; sphincter preservation; anastomotic leakage; survival
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2023.2278238

Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression). We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer. The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63;  = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis. This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.