Description:
<jats:p> 589 </jats:p><jats:p> Background: The objective of this trend analysis was to assess whether clinical outcomes following rectal cancer resection have improved over a 15-year time period. </jats:p><jats:p> Methods: The present study is based on the colorectal database of the authors` hospital, one of the largest tertiary care centers of Switzerland. All patients undergoing a rectal cancer resection for stage I - IV disease were consecutively included between 1991 and 2005. The 15-year time period was subdivided into five 3-year periods, among which different outcomes were compared. All tests were two-sided, the level of statistical significance was set at 0.05. </jats:p><jats:p> Results: Overall, 682 consecutive patients undergoing a rectal cancer resection for stage I - IV disease were included. Mean age was 65 years (range: 24 to 93 years), 62.1% of patients were male, median ASA physical status was 2 (range 1 – 4). Among the various time periods, there were no significant differences regarding patients` demographics as well as tumor stage. All following outcomes significantly decreased over time: operating room time (max. 217minutes to 164 minutes, P-trend: <0.001), rate of abdomino-perineal resections (from 20.5% to 7.6%; P-trend < 0.001), rate of R1/2 resections (from 16.9% to 8.6%; P-trend: 0.008), rate of intraoperative complications (from 16.9% to 4.9%; P-trend: 0.018), rate of general postoperative complications (from 59% to 35.1%; P-trend <0.001), and rate of local recurrence (8.4% to 4.9%; P-trend:0.033). 5-year overall survival did not significantly change over time, neither in the overall patient cohort (P-trend: 0.476), nor in the subsets of stage I-III (P-trend: 0.675) and stage IV patients (P-trend: 0.486). </jats:p><jats:p> Conclusions: This first study in the literature based on a large cohort of consecutive stage I – IV rectal cancer patients provides compelling evidence that that operating room time as well as rates of abdomino-perineal resections, R1/2 resections, intra- and postoperative complications, as well as rates of local recurrence have significantly decreased from 1991 – 2005. However, there was no significant improvement of overall survival, neither in the overall cohort nor in the subsets of stage I-III versus stage IV rectal cancer patients. </jats:p>