Outcome of Treatment of Rectal Cancer
NOND ROJV ACHIRANONDA, M.D.*, TANIT VAJRABUKKA, B.Sc., M.B., Ch.B., F.R.C.S. (Edin.), M.D.*
Affiliation : * Department of Surgery, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
Abstract
To demonstrate the trend and treatment outcome of rectal cancer after the advent of
adjuvant therapy, all case notes of rectal cancer patients admitted to Chulalongkorn Hospital from
1985-1994 were reviewed and cases were followed until 1996. Mean follow-up period was
685.3 days (8-3,193 days). Most rectal tumors were Dukes' C (43.8%), well-differentiated
(54.1%) and at the distal third (53.4% ). AP resection remained the most common procedure
before and after the advent of adjuvant therapeutic options (62.3%). Of 146 patients treated by
curative operations, 60 had adjuvant therapies of which radical radiotherapy with or without
chemotherapy was the most common. However, chemotherapy was increasingly employed as the
neoadjuvant and as combined chemoradiotherapy.
There was a preferential selection of less well-differentiated, more distal, more Dukes' C
disease and younger patients for the adjuvant therapy (p<0.05). Recurrence rate in the adjuvant
group was not different from the surgery group despite significant poorer prognostic indicators
(17.4% & 21.7%, p=0.53). Mortality was higher in Dukes' B+C patients in adjuvant group
(17.3% & 3.4%, p=0.02). The outcomes were not different among Dukes' A patients. The com-
plications; i.e. wound problems, gut obstruction; did not increase with the adjuvant treatment.
No adverse effect was observed on the healing of colorectal or coloanal anastomoses in the
adjuvant group.
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