Factors influencing outcome of surgery for stage I rectal cancer

Stage I rectal cancer (T1N0M0, T2N0M0) carries excellent prognosis with up to 90% of long term survival rates and complete cure can be expected with curative surgery. However 10 to 15% of these patients show local recurrence and mortality seen in five years. The aim of this study is to analyze the prognostic factors that influence the overall and disease free survival in patients with stage I rectal cancer. Eighty-five patients with stage I (T,T1N0M0, T2N0M0) rectal cancer that had potentially curative surgery were entered into the study. The patients were evaluated according to age, sex, preoperative carcinoembryonic antigen (CEA) level, type of surgical procedure, tumor distance from anal verge, tumor size, depth of invasion, histological differentiation, presence of tumor ulceration, periturnoral vascular invasion, periturnoral lymphatic invasion and peritumoral perineural invasion. Five year overall and disease free survival rates for the patients were 88% and 74%, respectively. Multivariate analysis showed that independent predictors of recurrence were differentiation and periturnoral vascular invasion, and independent predictor of overall survival was only differentiation. Stage I rectal cancer patients with poor differentiation and periturnoral vascular invasion are at high risk for recurrence and should be evaluated for adjuvant therapies.