The Northwest of England Rectal Cancer Trial

Abstract

In 1979 and 1980 more than 4000 cases of large-bowel cancer were treated annually in the Northwest region of England. Of these, 35.5% were within 13 cm of the anal verge. The prognosis following surgery in operable rectal cancer is 30% surviving at 5 years. A large proportion of patients die with evidence of recurrent rectal cancer in the pelvis. Local recurrence appears to be associated with invasion of tumor into surrounding structures which are not removed by conventional surgery [2, 3]. Of 48 patients with locally recurrent tumour investigated by computerised axial tomography (CAT) scanning at the Christie Hospital, 38 had disease limited to structure which were in contact with the original tumour before surgery [10]. In a recent MRC study [5] 765 cases of rectal cancer were assessed before surgery. When tumour appeared to have penetrated into surrounding structures, causing some loss of mobility, it was found that local recurrence following surgery was twice as common (70% versus 37% at 5 years). Furthermore, in over 60% of the cases with tumour penetration it was felt that a complete surgical resection could not be performed. Residual tumour in surrounding structures can regrow to give recurrence.

On behalf of the North West of England Rectal Cancer Group: Doctors Baillie, Bance-wicz, Bell, Buckler, Cade, Clegg, Cooper-Wilson, Crumplin, Done, Duari, Duthie, Eddies-ton, England, Forrest, Fussell, Haboubi, Hancock, Hartley, Hoare, Howat, Humphrey, Ingram, James, Johnson, Irving, Kingston, MacLennan, Main, Matheson, Moore, Neill, O’Brien, Ostick, Paley, Pearsonn, Salem, Schofield, Shafiq, Todd, Tweedle, Wilkinson, and Williams.

Acknowledgements to Mr. R. Swindell, Mrs. R. Hannom and Mrs. D. Driver for statistical Analysis.