Background: The treatment of rectal cancer has undergone pronounced changes during the last two decades. There has been a significant improvement in local tumor control due to consequent use of neo-adjuvant therapy and total mesorectal excision in cases of distal rectal cancer.
Aim: The presented analysis examined the implementation of the multimodal therapy for rectal cancer under the conditions of routine patient-centred care over a period of ten years.
In the process of the inauguration of novel diagnostic and therapeutic modes and procedures, data obtained in area-wide multi-center observational studies along the establishing period of time are indispensable.
This can be impressively detected considering the development of rectal cancer surgery in Germany over a 10-years study period based on original data from the Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg (Germany).
Method: The data acquired in the prospective multicenter observational study “Quality Assurance – Rectal Cancer” from the years 2000 to 2010 were analysed.
The main focus was directed onto the current trends, such as colonoscopy-screening, MRI (assessing involvement of the circumferential resection margin [CRM]), endoscopic ultrasonography, neoadjuvant treatment concepts, total mesorectal excision [TME] and laparoscopy–assisted surgical interventions as well as the early postoperative (rather surgical/operative) results and oncological long-term outcome.
Results (excerpt): From 01/01/2000 to 12/31/2010, overall 33,724 patients with rectal cancer were registered in Germany and evaluated according to quality assurance aspects.
The resection rate was 95.2%. The rate of curative resection was 84.2%.
No change was detected in perioperative total morbidity and lethality during the course of the study. The percentage of patients with neoadjuvant treatment and curative resection rose from 5.6% (2000) to 40.5% (2012). The rate of performed TME in distal rectal cancer rose from 75.2% (2000) to 95.3% (2012). For patients who underwent curative resection in the years 2000/2001, the 5-year local recurrence rate was 11.7%, while it was found to be 4.6% for patients who were thus treated in the years 2005/2006 (p<0.001). There was no mprovement of total survival.
Conclusion: While an increase in the use of neoadjuvant treatment for rectal cancer and the establishment of TME in routine patient-centred care have led to a significant improvement in local tumor control with a constant total morbidity and mortality, there is no detectable influence on the patients' total survival.
