Local recurrence following ‘curative’ surgery for large bowel cancer: II. The rectum and rectosigmoid

Abstract

1988 patients with an adenocarcinoma of the rectum (1292; 65 per cent) or rectosigmoid (696; 35 per cent) have been studied. A resection (1700 patients) or polypectomy (124 patients) was performed in 1824 (92 per cent) and, of the former, 1376 patients either underwent abdominoperineal (AP) excision of the rectum (788 patients) or an anterior resection (598 patients). The in-hospital mortality was 63 patients (8 per cent) for AP and 44 (7 per cent) for anterior resection, and a curative resection had been performed in 504 (71 per cent) of those undergoing an AP, and 393 (71 per cent) of those undergoing an anterior resection. Follow-up information is available for 478 patients (95 per cent) who underwent an AP and 370 (94 per cent) who underwent an anterior resection. More patients have developed a local recurrence after an anterior resection (67; 18 per cent) than after AP (57; 12 per cent) (Logrank chi2 = 6.6, d.f. = 1, P less than 0.02) (stratified for sex and Dukes' stage). This difference is not accounted for by a lesser margin of distal clearance after an anterior resection; firstly because the margin of clearance was not different in those who did and those who did not develop a local recurrence (AP: whole group = 4.4 cm, local recurrence = 4.5 cm; anterior resection: whole group = 3.0 cm, local recurrence = 3.1 cm) and secondly because for each centimetre of distal clearance there was a consistently greater probability of recurrence for anterior resection (Logrank chi2 = 9.1, d.f. = 1, P less than 0.01) (stratified for sex, Dukes' stage and distal clearance margin).

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

“…The increased AL rate may be related to the number of highrisk low rectal anastomoses [38]. Conversely our in-hospital mortality of 2.3% is in the lower range compared to a multicentre studies from Germany (2.7-3.1%) [31,39], Sweden (1-4% ) [28], Norway (3.0%) [33] and United Kingdom (7%) [25].We found that hospital case volume correlated with a lower incidence of AL. Others have found that higher surgeon case volume is associated with lower rates of morbidity regardless of the hospital case volume [28,32,40].…”

“…Only a minority of studies are nationwide multi-institutional surveys [31][32][33]. Comparison of complication rates between series is difficult because of the different referral patterns and different study periods, and because relatively few studies distinguish between colon and rectal site, since the incidence of AL is higher after rectal cancer surgery [5,25].The aim of this study was to assess the incidence and gravity of AL after surgery for rectal cancer performed by Italian colorectal surgeons, and to identify factors predicting the incidence and gravity of AL in this patient population. …”

Long‐term results of reirradiation for patients with recurrent rectal carcinoma

“…[1][2][3] Although the use of adjunctive preoperative or postoperative chemotherapy/radiation therapy has reduced considerably the incidence of local recurrence, approximately 10 -15% of patients still develop recurrence of the disease in the pelvis. 4,5 Salvage surgery for the recurrent carcinoma is rarely successful.…”

Do Types of Perforation Impact Outcomes in Perforated Stage II/III Colorectal Cancer Patients?

“…With regard to the pattern of recurrence, some reports have stated that tumor perforation was associated with highly local and peritoneal recurrence similar to hematogenous recurrence (10,14,15), whereas the pattern of recurrence in oral perforation has been infrequently reported. In the present study, the rate of recurrence was 39% (7/17) in group A and 29% (6/18) in group B.…”