Key result
Intraoperative adverse events occurred in 55% of rectal cancer resection surgeries and were an independent risk factor for local recurrence (HR 3.1).
Why the study?
While nonradical resection and intraoperative rectal perforation are known risk factors for local recurrence after rectal cancer surgery, the prognostic importance of other intraoperative adverse events was unknown.
Does the occurrence of intraoperative adverse events increase the risk of local recurrence in patients undergoing primary resection surgery for rectal cancer?
Cohort (n=1,208)
Yes
Does the occurrence of intraoperative adverse events increase the risk of local recurrence in patients undergoing primary resection surgery for rectal cancer?
Hazard Ratio: 3.1 (95% CI 2.7–3.7)
Absolute Event Rate: 9.3% vs 3.1%
p-value: p=<0.001
Intraoperative adverse events during rectal cancer surgery are an independent risk factor for local recurrence and could help identify patients needing intensified postoperative surveillance.
Other intraoperative adverse events were associated with higher local recurrence; leaves open need for prospective validation before practice change.
AIM: Failure to achieve a radical resection as well as intraoperative rectal perforation are important risk factors for local recurrence after rectal cancer surgery, but the importance of other intraoperative adverse events for the prognosis is unknown. The aim of this study was to assess the occurrence of intraoperative adverse events during rectal cancer surgery, and to determine whether these were associated with an increased risk of local recurrence. METHODS: A retrospective population-based cohort study was undertaken, including all patients in Region Västra Götaland, Sweden, who had undergone primary resection surgery for rectal cancer diagnosed between 2010 and 2014, registered in the Swedish Colorectal Cancer Registry. Data were retrieved from the registry and through review of the medical records. RESULTS: In total, 1208 patients were included in the study of whom 78 (6%) developed local recurrence during the follow-up period of at least 5 years. Intraoperative adverse events were common and occurred in 62/78 (79%) of patients with local recurrence compared to 604/1130 (53%) of patients without local recurrence. In multivariate analysis intraoperative adverse events were found to be an independent risk factor for local recurrence of rectal cancer, as were nonradical resection, a high pathological T stage, the presence of lymph node metastases, type of surgery and refraining from rectal washout during anterior resection and Hartmann's procedure. CONCLUSIONS: Intraoperative adverse events were found to be an independent risk factor for local recurrence of rectal cancer and could possibly be used together with other known risk factors to select patients for intensified postoperative surveillance.
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Waldenstedt et al. (2021) conducted a cohort in Rectal cancer (n=1,208). Intraoperative adverse events vs. No intraoperative adverse events was evaluated on Local recurrence of rectal cancer (HR 3.1, 95% CI 2.7-3.7, p=<0.001). Intraoperative adverse events occurred in 55% of rectal cancer resection surgeries and were an independent risk factor for local recurrence (HR 3.1).
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