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Objective In gastrointestinal cancer, serosal involvement indicates advanced disease. We looked at the possible role of clinical peritoneal involvement (CPI) in local recurrences (LRs) and the overall survival of patients with rectal cancer (RC). Method Between 1993 and 2002, 6404 patients were diagnosed with RC. Based on macroscopic findings at surgery and corresponding histological findings, 166 patients (3%) had CPI. Surgery was stratified according to type and extent of operation: as resective or nonresective surgery and as curative (R0) or noncurative (R1 or R2) resection. Results The presence of CPI was a negative factor for survival with a median of 15 months (95% CI, 12–19) in the presence of CPI compared with 65 months (95% CI, 61–70) without it ( P < 0.001). In R0 resections, the median survival was 97 months (95% CI, 90–102) in patients without CPI compared with 48 months (95% CI, 22–74) in patients with CPI ( P < 0.001). In R1 or R2 resections, the median survival was 16 months (95% CI, 15–17) in the absence of CPI and 9 months (95% CI, 8–10) in the presence of CPI. The LR rate in patients without CPI was 10.2% compared with 15.7% in patients with CPI ( P = 0.022). Conclusions Clinical peritoneal involvement is a significant detrimental prognostic factor for the LR of RC and survival in the absence of metastases. Observations from this large national cohort add to what is known about peritoneal involvement. Diagnosed CPI should be taken into consideration when adjuvant treatment strategies are addressed. [ABSTRACT FROM AUTHOR]

Objective Whether resection of the primary tumour is of benefit to patients with incurable rectal cancer (RC) remains a matter of debate. In this study we analyse prospectively recorded data from a national cohort. Method Among 4831 patients diagnosed with RC between 1997 and 2001, 838 (17%) patients were treated with palliative surgery. Patients were stratified according to disease stage, age and type of surgery. Results A significantly longer median survival, 12 (range 10–13) months, was observed in patients treated with resection of the primary tumour compared with 5 (range 4–6) months in patients treated with nonresective procedures ( P < 0.001). Median survival in months was significantly ( P < 0.001) related to age (13; < 60 years of age, 10; 60 to 69 years, 7; 70 to 79 years, 6; ≥ 80 years of age). In patients over 80 years, survival was similar regardless of the treatment. Thirty-day mortality varied from 2.5% to 20%, according to age groups. Conclusion The longer survival observed in patients with resection of the primary tumour may partly be explained by patient selection. Elderly patients (≥ 80 years) had a similar survival, irrespective of resection of the primary tumour or not. Careful consideration of the individual patient, extent of disease and treatment-related factors are important in decision-taking for palliative treatment for patients with advanced RC. [ABSTRACT FROM AUTHOR]