It is well known that local recurrence is the most important prognostic factor of rectal carcinoma. However, even after undergoing radical resection of primary tumors and lymph nodes, about 4%-50% of patients with rectal carcinoma were reportedly with local recurrence. Clinicopathologically, the risk factors of local recurrence remain unclear heretofore. Therefore, a group from Guangdong Provincial People's Hospital has recently explored the risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma.
A research article to be published on August 14, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Wu ZY and his colleagues in the department of General Surgery, Guangdong Provincial People's Hospital reported that local recurrence occurred in 12.5% (7 of 56 cases) of patients with middle and lower rectal carcinoma.
Local recurrence was significantly associated with family history (Chi-square = 3.929, P = 0.047), high CEA level (Chi-square = 4.964, P = 0.026), cancerous perforation (Chi-square = 8.503, P = 0.004), tumor differentiation (Chi-square = 9.315, P = 0.009) and vessel cancerous emboli (Chi-square = 11.879, P = 0.001). Local recurrence rate of patients with positive circumferential resection margin was 33.3% (4/12), whereas it was 6.8% (3/44) in those with negative circumferential resection margin. The difference between these two groups was statistically significant (Chi-square = 6.061, P = 0.014). They concluded that family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are significant risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma. Local recurrence may be more frequent in patients with mesorectal metastasis, compared with patients without mesorectal metastasis. Larger sample investigations are helpful to draw a further conclusion.
In this paper, authors explore the risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma. They demonstrated that family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are significant risk factors. It's an interesting paper.