gms | German Medical Science

Introduction: The objective of this trend analysis was to assess whether clinical outcomes following rectal cancer resection have improved over a 12-year time period.

Material and methods: The present study is based on the colorectal database of the authors’ hospital, one of the largest tertiary care centers of Germany. All patients undergoing a rectal cancer resection for stage I–IV disease were consecutively included between January 2002 to December 2013. The 12-year time period was subdivided into three 4-year periods, among which different outcomes were compared. All tests were two-sided, the level of statistical significance was set at 0.05.

Results: Overall, 1148 consecutive patients undergoing a rectal cancer resection for stage I–IV disease were included. Mean age was 63±12 years, 67% of patients were male. Among the various time periods, there were no significant differences regarding patients’ demographics as well as ASA stage, and 30-day mortality. All following outcomes significantly decreased over time: rate of patients with preoperative stage II and III disease, that were selected for neoadjuvant treatment (90% to 68%, P<0.0001), rate of sphincter preserving resections (87% to 78%, P=0.02), operative time (max. 245 minutes to 230 minutes, P <0.0001), hospital stay (from 11 days to 10 days). Ouctome measures that increased were the following: Patients with advanced disease stages (stage IV patients increased from 13% to 19%; P=0.01), median number of resected lymphnodes (from 15 to 16, P <0.001), rate of surgical complications (from 13% to 16%, P =0.02), rate of patients with adjuvant therapy (from 28% to 49%, P <0.0001). These trends were similar in the subset of patients with stage I–III rectal cancer patients. Stage specific local recurrence rate, overall- and disease free survival did not significantly change over time.

Conclusion: This first study in the literature based on a large cohort of consecutive stage I–IV rectal cancer patients demonstrates that many perioperative measures have significantly changed from 2002–2013. Interestingly, the decreasing number of stage II/III patients receiving neoadjuvant treatment did not result in a change in oncological outcome.