Adjuvante Radiochemotherapie. Verbessert ihr Einsatz nach einer totalen mesorektalen Exzision die Lokalrezidiv- und/oder die Überlebensraten bei Patienten mit Rektumkarzinom?

Based on the Consensus Conference of the NIH the German Cancer Society recommended adjuvant radiochemotherapy for patients with rectal cancer up to UICC stage II. Oncologically radical surgery as described by Heald (total mesorectal excision) was not part of this concept at this time. Meanwhile several studies show that the surgeon himself is one of the most important statistically »independent prognostic factor« in patients with rectal cancer. Improved surgical technique reduces local failure rate <5% and increases survival without postoperative adjuvant therapy. Therefore we studied two consecutive groups of patients with rectal cancer. Both were operated with TME. The first group received none, the second underwent adjuvant treatment. After a median follow up of 4 years local recurrence rate showed only a significant difference in subgroup analysis. Local failure rate after radiochemotherapy decreased statistically significant in patients with lymph node metastases, pT4 category or abdominoperineal rectum exstirpation. A tendency was seen in poor differentiated or distal tumor. In conclusion we intend to treat patients with adjuvant radiochemotherapy at UICC stage III or in high risk-tumors. Prospective randomized studies including optimized surgical management are necessary to characterize such patients with a benefit of adjuvant radiochemotherapy in local recurrence and survival rate.