Local recurrence after rectal cancer treatment in Manitoba

Background: By optimizing surgical and/or radiotherapy treatment, local recurrence rates of resectable rectal cancers have been reported to be less than 10% in both clinical trials and in some population-based studies. We examined patterns of care and local recurrence rates for rectal cancers in the province of Manitoba. Methods: We used the provincial cancer registry to identify all rectal cancers diagnosed from 1994 to 1997. These dates allowed for a minimum of 5 years of follow-up. We obtained information on cancer staging through a retrospective chart review and information on surgical procedures from the cancer registry. We included in our study only those patients with stages I, II and III disease who had an anterior resection, Hartmann procedure or abdominal perineal resection with clear margins. We determined local recurrences by chart review and we reported the crude rate. Results: We identified 333 patients among whom there was a relatively even distribution of stage I, II and III cancers. Fifty-three percent of patients received a stoma. Adjuvant radiotherapy was administered in 6%, 45% and 80% of patients with stage I, II and III cancers, respectively. Radiotherapy was only given preoperatively to 3 patients. We identified local recurrences in 13%, 16% and 24% of patients with stage I, II and III disease, respectively, with an overall rate of 17.4%. Recurrence rates by hospital ranged from 12% to 43%. Actual rates may be a few percentage points higher because 13% of patients had incomplete follow-up information and were assumed to have no recurrence. Conclusion: Between 1994 and 1997, the management of resectable rectal cancer in Manitoba did not meet benchmarks for the period in terms of documentation, treatment and, most importantly, the outcome of local recurrence. Initiatives should be taken to ensure that current performance and outcomes have improved.