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Rectal cancer responds favorably to radiation therapy given before surgery is performed. Swedish researchers have found that the introduction of a specific surgical technique combined with radiotherapy results in an impressive decrease in recurrence rates.
"Workshops started in 1994 and included 11 television-based demonstrations and two histopathology sessions" to teach surgeons the modified surgical approach, Dr. A. Lehander Martling and colleagues of the Stockholm Colorectal Cancer Study Group and the Basingstoke Bowel Cancer Research Project explain in the July 8th issue of The Lancet.
Histopathology refers to the study of diseased tissue and in these sessions, surgeons were given intensive training in the new procedure, called total mesorectal excision, which aimed to improve the precision of surgery for rectal cancer.
After analyzing surgeries and their outcomes for 447 patients in 1995-1996, and comparing them with procedures performed prior to the introduction of the new program, the researchers determined that the "initiative had a major effect on cancer outcomes" including a decrease in cancer recurrence of more than 50%.
According to the study report, the decrease was not only limited to recurrence of local disease. The percentage of major abdominal surgery procedures dropped from 60% to 27%, which the authors attribute to several factors including the new surgical technique.
Also, "the rate of early deaths due to rectal cancer was lower in the...project group...(which) may be explained by a lower frequency of local recurrence and by a lower frequency of distant metastases after local recurrence," the team writes. That is, recurrences occurred less often but when they did occur, the disease was less likely to have spread to other, more distant areas of the body.
Continued follow-up of patients should yield additional information about the true frequencies of recurrence in patients who underwent the new surgical procedure, the study authors conclude.
SOURCE: The Lancet 2000;356:93-96.
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