Proximal and distal rectal cancers differ in curative resectability and local recurrence

Table 1 Comparison of patients with proximal and distal rectal cancer

Criteria	Proximal rectal cancer (n = 100)	Distal rectal cancer (n = 118)
Age (median, range, yr)	60 (23 -88)	57 (19 – 85)
Gender
Male	54	66
Female	46	52
ASA status
1	26	32
11	50	68
111	20	16
1V	4	2
Type of operation
Elective	80	113
Urgent/emergent	20	5
Mean height of lower limit of tumor from anal verge (cm)	10.5	4.5

ASA: American Society of Anesthesia.

Table 2 Complications of operation for rectal cancer n (%)

Location complication	Proximal rectal cancer (n = 100)	Distal rectal cancer (n = 118)
Urinary retention	2 (2)	11 (9.3)	P = 0.412
Chest infection	4 (4)	4 (3.4)
Wound infection	3 (3)	2 (1.7)
Pelvic abscess	3 (3)	1 (0.8)
Anastomotic leak1	2 (2.5)	7 (8)

¹In consideration of anastomotic leakage, those who had had a Hartmann operation, Paul-Mickulicz procedure and trans-anal resection in the proximal rectal cancer group (n = 21) and abdomino-perineal resection and trans-anal resection in the distal rectal cancer group (n = 29) were excluded;

²Fisher’s exact test.

Table 3 Operative procedures for rectal cancer in 218 patients

Operation	Proximal rectal cancer	Distal rectal cancer
High anterior resection of rectum	23 (23)	0 (0)
Anterior resection of rectum	9 (9)	3 (2.5)
Low anterior resection or extended low anterior resection	44 (44)	75 (63.5)
Abdomino-perineal excision of rectum	0 (0)	23 (19.5)
Hartmann’s operation	16 (16)	5 (4.2)
Paul Mickulicz operation	4 (4)	0 (0)
Subtotal colectomy	1 (1)	4 (3.4)
Restorative proctocolectomy with ileal anal pouch anastomosis	2 (2)	7 (6)
Transanal resection	1 (1)	1 (0.8)
Total	100 (100)	118 (100)

Table 4 Histological characteristics of patients with proximal and distal rectal cancer

Histological criteria	Proximal rectal cancer (100)	Distal rectal cancer (118)
Differentiation1
Well	21 (21)	17 (14)
Moderate	69 (69)	83 (70)
Poor	8 (8)	10 (9)
Presence of mucin
Mucinous	5 (5)	9 (8)
Signet ring	0 (0)	1 (1)
Tumour stage2
T1	9 (9)	8 (7)
T2	20 (20)	28 (24)
T3	57 (57)	66 (56)
T4	14 (14)	16 (14)
Node stage3
N0	58 (58)	58 (49)
N1	15 (15)	30 (25)
N2	21 (21)	28 (24)
N3	3 (3)	0 (0)

¹Degree of differentiation not included in 10 patients (proximal rectal cancer 2 and distal rectal cancer 8) who showed complete tumour regression following pre operative chemoradiation;

²Reported T stage in those having neo-adjuvant therapy is stage before chemoradiation;

³Data regarding 5 patients have been withheld because either < 12 nodes were reported (n = 2) or no nodes were found after pre-operative chemoradiation (n = 3).