Análisis de los factores de riesgo de efectos adversos oncológicos en la cirugía del cáncer de recto

Abstract

Rectal cancer (RC) accounts for about one-third of the colorectal cancers which are diagnosed. Several factors, including total mesorectal excision, multidisciplinary approach, individualized treatment and perioperative care have substantially modified the prognosis of patients operated on for RC. In this study, we retrospectively analyzed demographic, preoperative, surgical and pathological variables from 445 patients diagnosed with RC, who underwent surgery with curative intent between 2008 and 2017, aiming to assess their impact on locoregional and distant recurrence, overall survival (OS) and disease-free survival (DFS). Given the existing controversy about the prognostic role of the nodal staging of the TNM system, the secondary aim was to assess the prognostic validity of TNM and other classifications,such as the Lymph Node Quotient (GLC) and the Logarithm of Positive Lymph Nodes (LODDS). A descriptive study of the variables analyzed in the study and an analysis of the impact of each of them with recurrence and survival were carried out. A stratification was made within the staging systems studied, together with their relationships with the number of nodes examined (≥12 or <12), in order to identify prognostic subgroups for OS and DSF. Several variables were found to be independent prognostic factors of an unfavorable oncological evolution: tumor localization in the lower rectal third, poorly differentiated tumors, rectal perforation, affected circumferential margin, perineural invasion, ASA III-IV grade, need for perioperative transfusion and unsatisfactory mesorectal quality. LODDS provided a more accurate predictive value in patients with negative nodes than the N status and CGL classification, showing significantly better staging for OS and DFS than the other systems, and it could be used to identify patients who may benefit from stricter cancer monitoring