Changing strategy for rectal cancer is associated with improved outcome

Background: In 1980, surgery for rectal cancer at the Department of Surgery, Uppsala University Hospital was concentrated to a colorectal unit and a more systematic use of adjuvant radiotherapy began. In 1985, total mesorectal excision was introduced. The aim of this study was to determine whether these changes had an impact on the overall treatment outcome. Methods: Some 423 consecutive patients with rectal cancer had surgery between 1974 and 1995 and were followed up until 1 January 1998. Outcome analysis was made according to the following predefined intervals of diagnosis: 1974-1979, 1980-1984 and 1985-1995. Results: The overall local recurrence rate was 47 per cent in the first interval, and 13 and 11 per cent during the second and third respectively (P < 0.001). In the third interval, of 119 patients who received preoperative irradiation and underwent radical resection, only three (3 per cent) had locally recurrent rectal cancer. There was improved cancer-specific survival between the first and the last intervals of the study (P = 0.03). Conclusion: These data are consistent with the interpretation that the results of treatment can be improved by concentration of surgery to a colorectal team.