PURPOSE: This prospective study was designed to assess the outcome through the first five years after the introduction of total mesorectal excision in 1993 in a Norwegian central hospital, with special regard to the difference between low (≤6 cm from anal verge) and high (> 6 cm) rectal cancers. METHODS: A total of 140 patients (81 males; median age, 64 (range, 29-87) years) underwent surgery for rectal cancer under curative intention. Local recurrence rates were 8 of 44 (18 percent) for the low cancers and 5 of 96 (5 percent) for the high, a statist ically significant difference (P = 0.0014). Corresponding numbers when the R1 re sections are excluded were 5 of 36 (13 percent) for the low and 4 of 92 (4 perce nt) for the high cancers (P = 0.002). The five-year survival after R0 resection s of cancers 6 cm. The fi ve-year overall survival for the whole material was 72 percent. CONCLUSIONS: Su rgery alone for rectal cancer can achieve overall good results, with five-year overall survival of 72 percent. The prognosis of the cancers of the lower rectum seems to be inherently different from the tumors of the higher level, both conc erning local recurrence and five-year survival, suggesting different biologic b ehavior of the two cancers.
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