Clinico-epidemiologic criteria and predictors of survival of rectal cancer among Egyptians in Delta region

Metwally, Islam H.; Abdelkhalek, Mohamed; Elbalka, Saleh S.; Zuhdy, Mohamed; Fareed, Ahmed M.; Eldamshity, Osama

doi:10.1016/j.jcol.2019.07.004

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Journal of Coloproctology (Rio de Janeiro)

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Original Articles • J. Coloproctol. (Rio J.) 39 (4) • Oct-Dec 2019 • https://doi.org/10.1016/j.jcol.2019.07.004 copy

Clinico-epidemiologic criteria and predictors of survival of rectal cancer among Egyptians in Delta region

Critérios clínico-epidemiológicos e preditores de sobrevida do câncer retalentre egípcios na região do Delta

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Colorectal cancer represents a global health problem. Rectal cancer in particular is increasing and is believed to carry a unique epidemiologic and prognostic criteria.

Method

We herein study retrospectively the data of 245 patients from a tertiary center in Egypt. Clinico-epidemiologic criteria and predictors of survival are analyzed.

Results

The disease affects younger population without sex predilection. Prognosis is affected by age, nodal status, metastasis, and bowel obstruction.

Conclusion

Rectal cancer has unique criteria in the Egyptian population. A national population based registry is recommended to delineate the nature of the disease in Egypt.

Keywords
Rectal cancer; Registry; Metastasis; Survival; Recurrence

Variable	Patients
Age at diagnosis	Mean 47.2 (SD = 14.5)
Sex	124 females and 121 males.
BMI	Mean 32.2 (SD = 7.5)
Distance from anal verge by proctoscopy	Median 5 cm
Radiologic Tumour size	Median 4 cm (maximum 13 cm)
Tumour form	35.5% polypoid, 26.5% ulcer and 20.8% stenosis.
Nodal status at diagnosis radiologically	38.8% node positive
Metastases at diagnosis	21.3% metastatic at diagnosis with this order of frequency (liver, peritoneal, lung, multivisceral, bone and finally non-regional nodes).
Preoperative therapy	34.7% received NART while 43.3% received NACT.
Operation	LAR in 25.7%, APR in 21.2%, ultraLAR in 9.4%, Exploration in 7.3%, ISR in 6.1%, pelvic exenteration in 2.8% and local excision in 2.7%.
Anastomosis	Commonest end to end in 62.7%.
	56% were hand-sewn and 28.6% single stapling technique
Ostomy	76.6% of operated cases
	Commonest type loop ileostomy in 35.4% followed by terminal colostomy in 27.2% then loop transverse colostomy in 22.4%.
Operative time	Mean 270 minute (SD = 113).
Operative blood loss	Median 350 ml (range 150‒3000).
Hospital stay	Median 9 days (range 1‒45).
Oral intake	Median 3 days (range 1‒17).
Pathology	Conventional adenocarcinoma in 66% followed by mucinous carcinoma in 25.9% then signet ring in 6.6%.
Lymph node harvest	Median 8 (range 0‒26), with 70% have less than 12 node resected.
Number of positive lymph nodes	Median 1 with maximum of 22 infiltrated.

Factor	Estimated mean survival (months)	p-value
Overall Survival
Age at diagnosis		0.047
Young (<40)	179.6
Old (>40)	136.6
Treatment goal		0.045
Curative	156.2
Palliative	50.4
3º day morbidity		0.001
Not encountered	104
Encountered	48
Disease Free Survival
Sex		0.02
Male	49.7
Female	111
Metastasis at diagnosis		0.00
Present	8.3
Absent	69.9
Metastasis site		0.02
Liver	16.5
Other	1.7
Intestinal obstruction		0.00
Presentation with IO	0.5
Without IO	90.5
Pathologic T		0.032
Pathologic N		0.001
N0	76
N1	60
N2	41
Longitudinal margin		0.028
Free	71.9
Infiltrated	39.3

Factor	Hazard ratio (95% CI)	p-value
Overall Survival
Old age at diagnosis (>40)	10.8 (1.3‒91.9)	0.03
Palliative treatment goal	7.2 (1.4‒36.2)	0.017
Presence of 3º day postoperative morbidity	5.4 (1.7‒17.2)	0.004
Disease Free Survival
Male sex	1.5 (0.7‒2.9)	0.26
Metastasis at diagnosis	5.5 (2.2‒13.4)	0.00
Metastasis to sites other than liver	6.1 (0.7‒51.8)	0.095
Presentation with intestinal obstruction	32.9 (4.4‒248.1)	0.001
Pathologic T stage		0.124
Pathologic N stage		0.049
N1	1.1 (0.4‒2.8)	0.84
N2	2.4 (1.1‒5.1)	0.023
Infiltrated longitudinal margin	1.4 (0.4‒4.7)	0.63

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[1] *Corresponding author. E-mail: drislamhany@mans.edu.eg (I.H. Metwally).