• Eur. J. Cancer · May 2009

    The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer.

    • Marcel den Dulk, Hein Putter, Laurence Collette, MarijnenCorrie A MCAMDepartment of Radiotherapy, NKI-AVL, Amsterdam, The Netherlands., Joakim Folkesson, Jean-Francois Bosset, Claus Rödel, Krzysztof Bujko, Lars Påhlman, and van de VeldeCornelis J HCJHDepartment of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl..
    • Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
    • Eur. J. Cancer. 2009 May 1; 45 (7): 1175-1183.

    PurposeThe aim of this study is to identify factors associated with the decision to perform an abdominoperineal resection (APR) and to assess if these factors or the surgical procedure itself is associated with circumferential resection margin (CRM) involvement, local recurrence (LR), overall survival (OS) and cancer-specific survival (CSS).Patients And MethodsThe Swedish Rectal Cancer Trial (SRCT), TME trial, CAO/ARO/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial (PRCT) were pooled. A propensity score was calculated, which indicated the predicted probability of undergoing an APR given gender, age and distance, and used in the multivariate analyses.ResultsAn APR procedure was associated with an increased risk of CRM involvement [odd ratio (OR) 2.52, p<0.001], increased LR rate [hazard ratio (HR) 1.53, p=0.001] and decreased CSS rate (HR 1.31, p=0.002), whereas the propensity score was not.ConclusionThe results suggest that the APR procedure itself is a significant predictor for non-radical resections and increased risk of LR and death due to cancer for patients with advanced rectal cancer.

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