Improved overall survival for patients with rectal cancer since 1990: The effects of TME surgery and pre-operative radiotherapy

Abstract Aim The aim was to study the effects of the introduction of TME surgery and pre-operative radiotherapy on overall survival (OS) by comparing patients treated in the period before (1990–1995), during (1996–1999) and after (2000–2002) the TME trial. Patients and methods Patients diagnosed with rectal carcinoma in the region of Comprehensive Cancer Centres South and West were used ( n = 3179). Results Five-year OS was, respectively, 56%, 62% and 65% in the pre-trial, trial and post-trial periods ( p < 0.001). Pre-operative RT was increasingly used over time and significantly related to OS in the post-trial period ( p = 0.002), but not in the pre-trial and trial periods. Conclusions Population-based OS improved markedly since the introduction of TME surgery. With standardised TME surgery, pre-operative RT improved OS, whereas withholding pre-operative RT was associated with a poorer prognosis. The present study supports that pre-operative RT was correctly introduced as a standard treatment before TME surgery in our national guideline.