Survival after surgical treatment of cancer of the rectum

Background and aims: Rectal carcinoma is one of the most prevalent tumour types. Prognostic factors are of special interest to estimate prognosis of the individual patient. Patients/methods: The data of 1,067 consecutive patients with solitary invasive rectal carcinoma, resected between 1988 and 1999 at the Department of Surgery of the University of Erlangen, were analysed. Cancer-related survival rate was calculated by univariate and multivariate analysis with respect to all relevant proven and probable prognostic factors. Results: The R classification was found to be the parameter with the greatest influence on survival of patients with rectal carcinoma. Other tumour-related prognostic factors that influenced prognosis significantly were the anatomical extent, described by the TNM classification of the UICC, tumour grade and extramural venous invasion (EVI). In addition, the operating surgeon, a therapy-related factor, and the preoperative serum CEA level were found to influence prognosis. Conclusion: Tumour-related prognostic factors have the greatest influence on clinical decisions with regard to choice of a therapeutic concept. The increasing survival rates after treatment of rectal carcinoma have led to a focus on postoperative quality of life. Postoperative long-term global quality of life is similar to the preoperative level. Oncological outcome is still the most important factor, and tumour recurrence leads to a strong impairment of quality of life.