Analysis of the prognostic factors for low rectal cancer with the pT1-2NxM0 stage after abdominoperineal resection

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Abstract

Objective

This study was designed to explore the factors influencing local recurrence and survival for low rectal cancer with pT1-2NxM0 stage after an abdominoperineal resection (APR).

Methods

Data of 429 patients confirmed to have pT1-2NxM0 after APR were reviewed.

Results

The recurrence rate in patients with intraoperative perforation, less than 12 lymph nodes (LNs) harvested, T2 staging, and positive circumferential resection margin (CRM) was 25.1, 19.9, 9.5, and 26.1% compared with 6.9, 7.0, 0, and 5.8% in patients with no perforation, 12 or more LNs harvested, T1, and negative CRM. The 5-year survival rate in patients with age of at least 70, perforation, less than 12 LNs harvested, T2, and positive CRM was 71.1, 60.8, 58.8, 69.9, and 46.0%, but 73.4, 73.5, 73.8, 89.4, and 75.0% in patients with age less than 70, no perforation, 12 or more LNs harvested, T1, and negative CRM. Meanwhile, patients with N0, N1, and N2 had a survival rate of 90.7, 69.9, and 63.9%. Multivariate analysis showed that perforation (P<0.001), number of LNs harvested (P<0.001), T staging (P<0.001), differentiation (P=0.045), and CRM status (P=0.002) were associated with local recurrence, whereas age of the patients (P=0.023), N staging (P<0.001), differentiation (P=0.011), and CRM status (P=0.004) were associated with survival.

Conclusion

APR was affected by patients’ age, operation performer, perforation, number of LNs harvested, T staging, N staging, differentiation, and CRM status. Perforation, number of LNs harvested, T staging, differentiation, and CRM status were independent factors for recurrence; meanwhile, age of the patients, N staging, differentiation, and CRM status were independent factors influencing survival.

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