Aims: There is limited information on the surgical management of rectal cancer in China. This retrospective clinical study compares surgical treatment practices in 2860 cases from China with 1916 cases from Australia over the period from 1995 to 2012, and examines whether the use of abdominoperineal resections has changed in both countries.
Methods: Data on rectal adenocarcinoma cases undergoing anterior or abdominoperineal resection were collected from six institutions in Australia and one institution in China. Clinicopathological characteristics and trends in abdominoperineal resections were compared using chi-square tests and their associations with abdominoperineal resections were tested using logistic regression.
Results: Chinese patients were significantly younger (mean 57 vs 65 years, P <0.0001), more likely to be female (42% vs 36%, P =0.001), and more likely to undergo an abdominoperineal resection (P =0.001) compared to Australian patients. The abdominoperineal resection rate in China has declined significantly in the past 17 years (P for trend < 0.0001) whereas no change in the abdominoperineal resection rate was observed in Australia over the same timeframe. In the Chinese cohort younger age, male gender and advanced tumour stage were associated with a greater likelihood of receiving abdominoperineal resection surgery.
Conclusions: Significant differences in patient demographics, tumour characteristics and treatment modalities were observed in rectal cancer cases from China compared to Australia. Rectal cancer surgery in at least one centre in China has shifted in favour of sphincter-preserving treatments in recent years. Given the aging Chinese population, an increasingly 'Westernised' lifestyle and rising incidence of colorectal cancer in China, it will be increasingly important that future research continues to involve collaborative data sharing between Eastern and Western countries.