Aggressive versus conventional strategies in the treatment of rectal adenocarcinoma

Objective: Comparison of an aggressive approach (including total mesorectal excision and combined modality adjuvant therapy) with a conventional approach in the treatment of primary rectal cancer. Design: Retrospective study. Setting: Memorial Sloan-Kettering Cancer Centre, New York (MSKCC) and University Hospital Leiden, the Netherlands (UHL). Subjects: One hundred and sixty-nine patients treated at MSKCC and 96 patients treated at UHL. Interventions: Total mesorectal excision (MSKCC) and conventional resection (UHL). Main outcome measures: Overall survival and local recurrence-free survival. Results: Five-year overall survival was 73% for MSKCC patients and 52% for UHL patients [ P < 0.001). Five-year local recurrence-free survival was 83% for MSKCC patients and 72% for UHL patients ( P = 0.001). Relative risk of dying or developing a local recurrence was 3.37 and 2.61, respectively, for patients treated at UHL compared to patients treated at MSKCC ( P < 0.001 and P = 0.008, respectively). Conclusions: These data suggest that an aggressive approach including total mesorectal excision and combined modality adjuvant therapy improves survival and local control compared to a conventional approach.