PURPOSE: Total mesorectal excision (TME) and other technical surgical factors reduce local recurrence rate in @entity5 . Scientific evidence of the positive effect of optimal surgery on survival is locking. Whether a reduction in the incidence of distant metastases can be achieved with optimal surgery is uncertain. We examine the effects of the quality of surgery, as reflected by local recurrence rate, on survival and the incidence of initial distant metastases. @entity1 AND METHODS: Between 1974 and 1991, 1,581 consecutive @entity1 who underwent curative resection (RO) for @entity189 were monitored for recurrence and survival. TME was introduced in 1985. No @entity1 received adjuvant radiotherapy or chemotherapy. The median follow-up time was greater than 13 years. RESULTS: The local recurrence rate decreased from 39.4% to 9.8% during the study period (P < .0001). The observed 5-year survival rate improved from 50% to 71% (P < .0001). Three hundred six @entity1 with local recurrence had a significantly lower observed 5-year survival rate (P < .0001). A total of 1,285 @entity1 had no local recurrence, but 275 of them developed distant metastases (International Union Against Cancer [UICC] stage I, 8%; stage II, 16%; stage III, 40%). Better-quality surgery had no effect on the incidence of initial distant metastases, which remained constant (P = .44). CONCLUSION: Quality of surgery is an independent prognostic factor for survival in @entity5 , but has no influence on initial occurrence of distant metastases. Local recurrence cannot be considered an outcome criterion of adjuvant treatment without consideration of the surgeon as a risk factor.

Influence of surgery on metachronous distant metastases and survival in XXXX .

@entity5 :: ('MESH:D009369', 'Disease') :: ['rectal cancer'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'PATIENTS'] @entity189 :: ('MESH:D002277', 'Disease') :: ['rectal carcinoma']
@entity5 :: (MESH:D009369,Disease) :: ['rectal cancer']
