• Two new biologically composite systems of staging were used to analyze the patterns of presentation, therapy, and outcome for 318 patients with rectal cancer.
Selectional bias was evident in therapeutic decisions. The patients chosen for surgical exploration and possible resection came mainly from prognostically favorable stages and had higher survival rates than the "inoperable" patients even when the tumor was not resected.
In patients with tumors located 8 cm or higher above the anus, survival rates in each composite symptom-anatomic (S-A) stage were essentially similar with radical and simple resections. Radical surgery gave better survival rates than simple surgery for tumors at 5 to 7 cm and was an anatomic necessity to remove tumors at 0 to 4 cm. Regardless of the extensiveness of surgery, the S-A stages were directly related to rates of postoperative infection, postoperative death, subsequent quality of life, and deaths due either to cancer or to noncancer causes.
(Arch Intern Med 135:1454-1462,1975)
Feinstein AR, Schimpff CR, Hull EW. A Reappraisal of Staging and Therapy for Patients With Cancer of the Rectum: II. Patterns of Presentation and Outcome of Treatment. Arch Intern Med. 1975;135(11):1454–1462. doi:10.1001/archinte.1975.00330110044007
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