Improved local control of rectal cancer reduces distant metastases

Aim The purpose of the present national study was to determine whether improved local control has been accompanied by a change in the incidence of metastases. Method The data were from a national population-based rectal cancer registry and included all 6501 rectal cancer patients treated for cure. The study periods were 19931997, 19982000, 20012003 and 20042006. Results Major changes in the handling of rectal cancer from the first to the last study period included an increased use of MRI from zero to 81% and the use of preoperative radiotherapy from 5% to 20%. The proportion of patients with circumferential resection margin (CRM) = 2 mm decreased from 23% to 13%. The 4-year rate of local recurrence decreased from 13% to 8% (P < 0.001), the overall survival increased from 65% to 73% (P < 0.001) and the incidence of distant metastases decreased from 25% to 19% (P < 0.001) from the first to the last period. The risk of metastases decreased by 29% (hazard ratio 0.71, 95% CI 0.600.84). Conclusion Improved diagnostics and treatment of rectal cancer aiming at better local control and survival have resulted in a significant reduction in the incidence of distant metastases.