Influential Factors in Genesis of Local Recurrence

Local recurrence has different features, depending on several factors: tumour characteristics, patient constitution, and surgeon's knowledge and ability.

Tumour characteristics, well known to affect the risk of local recurrence, are: location, size, mobility and gross appearance - these are the first and easiest to be assessed. In order to evaluate more easily the impact of fixation of the tumor for the surrounding structures, recurrent tumours are classified as: F0, non-fixed; F1, fixed to one side; F2, two sides; and F3, three or more sides [9]. Afterwards, the pathohisto-logical report gives us more data: grade, stage and the potential presence of lymphatic, venous or perineur-al invasion. In addition, aneuploid tumors and those with a mucinous component have a negative impact on survival [10].

Patient constitution has two groups of risk factors. The first group consists of those that make surgery technically more difficult - narrow "male" pelvis, obese patients; it has also been noted that irre-sectability is earlier suspected or diagnosed in male patients [11]. The second group contains factors with negative influence on immunological status of the host - all types of immunodeficiency disorders (AIDS for example), some other systemic disorders, elderly patients and other non-related serious conditions.

The surgeon also plays an important role in genesis of local recurrence. Surgery for rectal cancer is difficult, and the surgeon and entire team of the institution where the patient is treated influence its results [12]. The results of the Stockholm trial and similar studies showed that high-volume surgeons in high-volume hospitals had significantly lower percentages of local recurrence (in the Stockholm trial, the local recurrence rate was 4% vs. 10% when comparing high- and low-volume surgeons, respectively [6]). Also, surgeons who underwent certain basic training more frequently performed TME, sphincter-saving operations and pre-operative radiotherapy (PRT) [6].

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