Effect on survival of advanced therapeutic approaches for patients with rectal cancer

This review evaluated the survival of patients with rectal cancer who were treated with a total mesorectal excision (TME) and whether preoperative chemoradiation therapy or PCRT (chemotherapy and radiotherapy before surgery) had any influence on their survival.

Rectal cancer is cancer in the rectum, the last part of the large intestine. This cancer can grow through the wall of the rectum, may extend into nearby tissues and organs and spread to the lymph nodes. The mesorectum is a fatty tissue attached to the rectum that contains blood vessels and lymph nodes. A total mesorectal excision (TME) is a type of surgery that aims at removing the cancer along with a significant part of the bowel and the mesorectum with the corresponding lymph nodes. Radiation therapy along with chemotherapy drugs before the surgical excision (PCRT) can be administered to these patients to shrink the cancer. This often makes surgery more effective. This review analyzed the efficacy of these therapeutic approaches in treating patients with rectal cancer.

This review analyzed studies that included overall 2,197 patients with rectal cancer who were treated between 1989 and 2006. The review divided the studies into 3 groups according to the time they were treated and the therapeutic approach used. Period 1 (P1) included 293 patients treated with TME between 1989 and 1995, period 2 (P2) included 836 patients treated with TME between 1996 and 2001 and period 3 (P3) included 1068 patients treated with PCRT and TME between 2002 and 2006. Patients from all groups were regularly followed up for at least 5 years.

Results showed that the 5-year cancer-specific survival (defined as the percentage of patients who have survived rectal cancer 5 years after treatment) had increased from 70% in P1 to 84.3% in P3. The 5-year disease-free survival (defined as the percentage of patients without any signs and symptoms of the disease 5 years after the treatment) had also increased from 64.3% in P1, to 69.8% in P2 and to 76.8% in P3. In addition, patients treated in the last years of P3 had a lower cancer recurrence (return of the cancer) rate compared to the other patients. 

In summary, during the past years survival rates have improved for patients with rectal cancer treated with TME. This survival benefit might be due to the addition of advanced therapeutic approaches such as PCRT, but also to developments that are being done to surgical techniques.

This research reviewed studies that had been done in the past, so the data included was based on patients’ information from the hospital records, which might have been incomplete or biased.