Population-based study of the treatment and prognosis of carcinoma of the rectum

Background Few population-based studies address the issue of treatment of carcinoma of the rectum (15 cm or less from the anal verge) both from surgical and epidemiological aspects. Methods Some 827 patients were analysed in the cancer registry of the Cote-d'Or (Burgundy, France) from 1976 to 1990 (493 931 inhabitants). Results Resection for cure increased from 57.2 per cent before 1981 to 77.0 per cent after 1985 (P<0.001), and the proportion of Dukes A and B cases from 35.8 to 52.5 per cent (P<0.001). Among patients resected for cure, continence-preserving resections were performed more frequently during the 1986-1990 period (48.0 per cent) than during the two previous 5-year periods (20.0 per cent; P<0.001), more often in women, in the upper half of the ampulla and for tumours of less than 45 mm. The operative mortality rate after curative surgery decreased from 13.9 to 3.7 per cent (P<0.001) between the first and the last period whereas the 5-year crude survival rate rose from 25.8 to 42.6 per cent (P<.0001). Age, stage of disease and period of diagnosis were independent prognostic factors of death in a relative survival model. Conclusion This study indicates that significant advances have been achieved at a population level in the treatment of rectal cancer in terms of diagnosis, continence-preserving procedures and survival.