Peritoneal reflection involvement as a prognostic factor in rectal cancer. Long-term oncological outcomes from a prospective study
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Purpose
To assess the relevance of peritoneal reflection involvement in long-term oncological outcomes in patients with rectal cancer.
Methods
Prospective observational study from a specialized colorectal unit that included a consecutive series of patients undergoing mesorectal excision for rectal cancer. Peritoneal reflection (PR) involvement was evaluated on pathological examination using Shepherd’s classification. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR) were assessed.
Results
One hundred sixty patients were included in the present analysis. Peritoneal involvement was present in 28.2% of the 85 tumors above or at the level of PR. There were no differences in OS, DFS, or LR according to tumor’s height location. The 5-year OS, DFS, and LR for tumors involving PR were 58.3%, 61.7%, and 30.3%, respectively. Patients with peritoneal involvement had a higher LR rate ( p = 0.02) and shorter OS ( p = 0.04). Shepherd’s grade 4 peritoneal involvement was an independent risk factor for OS (HR 2.9; 95% CI 1.1–9.5, p = 0.04) and LR (HR 4.2; 95% CI 1.2–16.9, p = 0.04).
Conclusion
After rectal cancer resection, peritoneal involvement is an independent risk factor for local recurrence and poor survival.
