Clinicopathological Spectrum and Management of Rectal Cancer in Durban South Africa

Background: Colorectal cancer is the fourth most common cancer in South Africa. Rectal cancer poses its own unique challenges. Objectives: The aim of this study was to document our experience with management of rectal cancer and to assess the long-term outcome of treatment. Methods: This was a retrospective analysis of prospectively collected data carried out at the Durban Colorectal Unit. Data on all patients with rectal cancer was extracted from the ongoing colorectal cancer database. Study outcomes were staging, surgical resection and recurrence. Results: A total of 1210 patients had rectal cancer (rectosigmoid 313, rectum proper 897). Mean age was 57.95 (+ 14.45) years. There were 645 (53.31%) males (M:F ratio 1.2:1). Six hundred and twenty-six patients (51.73%) underwent resection (rectosigmoid 139, rectum 487) of whom 272 had abdominoperineal resection (APR) (43.45%). Patients have been followed up for a median of 19.33 months (IQR 22). Overall resection rate was 51.99%; 44.4 % among rectosigmoid tumours and 54.29% among rectal tumours. Stage IV disease predominated in both rectosigmoid and rectal tumours at 31.6% and 26% respectively. Open surgery predominated in our study with 86.33% of patients with rectosigmoid tumours and 68% of patients with rectal tumours undergoing open surgery respectively. Conclusions: The age at presentation of our patients was lower than international literature. A high proportion of patients presented with stage IV disease. There was a slight male preponderance. The resection rate was just over 50 % of which APR contributed to less than 50%. Open surgery predominated in our study.