Original paper
Cancer of the rectum in male patients: factors influencing overall survival following anterior resection with total mesorectal excision for rectal cancer

Introduction: Due to introduction of total mesorectal technique (TME) into surgical management an optimal local control for rectal cancer can be achieved. Despite this advantage a lot of patients have a high risk of oncological relapse. Adequate adjuvant therapy can effectively improve long-term outcomes. Identification of unfavourable prognostic factors may be helpful to define patients who need more aggressive combined-modality treatment. The aim of the study was to estimate prognostic value of clinical and pathological features after anterior resection with TME for carcinoma of the rectum. Material and methods: 43 consecutive males operated on with sphincter-preserving TME technique were studied prospectively. Neo- or adjuvant therapy was used in UICC II and III stages. Five-year overall survival was calculated with Kaplan-Meier method and compared with log-rank test. P value <0.05 was considered statistically significant. Results: Postoperative mortality was not noticed. Overall five-year survival was 71.5±9.8%. Prognosis was significantly poorer for patients with tumour penetrating beyond the bowel wall, lymph-node metastases and enhanced preoperative CEA serum level. Survival was better for males with well differentiated cancer, lesion without mucinous histology, lymphocytic tumour infiltration, age less than or equal to 60 years, expanding growth type and cancer sited higher than 7 cm from the anal verge but with a lack of significance. Conclusions: Primary tumour penetration and lymph-node status remain significant prognostic factors following anterior resection with TME technique. Additionally enhanced preoperative CEA serum level can be helpful for identification of patients with high risk of oncological failure. Potential benefit from more aggressive combined-modality therapy for these patients should be evaluated in further studies.