Prognostic factors in rectal cancer: where is the evidence?

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Published Dec 19, 2017
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Vol. 95 No. 2 (2017): Issue Feb 2017

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Mehdi Khalfallah
Wejih Dougaz
Hichem Jerraya
Ramzi Nouira
Ibtissem Bouasker
Chadli Dziri

Abstract


Background:
In rectal cancer, the 5 years survival is about 53 % for all stages: it remains low in spite of the progress of diagnostic and therapeutic tools.
The aim of this work was to provide evidence based answers to the following question: what are the pre, intra and post operative prognostic factors in rectal cancer?
Methods:
We have carried out a search in the following data bases: Pubmed, Embase, Cochrane and Scopus. The key words used were: « rectal cancer », « adenocarcinoma », « overall survival », « disease-free survival », « prognosis » and « evidence-based medicine ». The overall 5 years survival rate has been retained as primary outcome measure. Recurrence-free survival has been retained as secondary endpoint. Were included meta-analyses and systematic reviews of clinical trials dating back to less than six years.
Results: 
We retrieved 270 publications, 27 articles only met the above-mentioned eligibility criteria and thereof have been retained in this work.
A high operating volume, a specialized surgeon in colorectal surgery, a total mesorectal excision, an adjuvant chemotherapy given within no more than 8 weeks following the curative resection improve prognosis in rectal cancer with level I of evidence. Anastomotic leak and diabetes worsen prognosis in rectal cancer with level I of evidence. Margin of surgical resection must be RO to improve prognosis in rectal cancer with level I of evidence.
Conclusion:
The main prognostic factors found in literature which we should keep in mind are those on which surgeons can  act:  neoadjuvant treatment,  high operating volume of the surgeon,  high tie of the inferior mesenteric  artery,  mesorectal excision , RO resection,  improvement of the techniques of intersphincteric resection and techniques of anastomosis   and adjuvant chemotherapy within less than 8 weeks when appropriate.

Keywords:

rectal cancer, prognosis, overall survival, disease-free survival, evidence-based medicine.

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