Operative Treatment of Locally Recurrent Rectal Cancer

Abstract

Few centres with varying regimens have published studies including more than 100 patients on the treatment of locally recurrent rectal cancer. The results vary considerably. Thus there seems to be a need for more studies to establish the potential benefit of a more widespread treatment of these cancers. In total, 193 patients had surgery for locally recurrent rectal cancers after preoperative irradiation 46-50 Gy in 2 Gy fractions. The patients were followed up and the data prospectively entered in a database. In 88 patients with primary low anterior resection, 3% had lower end of tumour located more than 2 cm above the anastomosis, 5% more than 2 cm below the anastomosis; 13% had exploratory laparotomy, 8% low anterior resections, the rest equally frequent abdomino-perineal resections, Hartmann's operations, and tumour resections. Nearly half had resection of part of the pelvic wall. Hysterectomy was performed in 15% and cystoprostatectomy in 9%. Three patients had en bloc prostatectomy. R0 resections were achieved in 39%, R1 in 36%, and R2 or no resection in 25%. R0 stage was twice as often achieved after a primary low anterior resection as after abdomino-perineal resections. The 30-days postoperative mortality was 1%. Postoperative morbidity was 48%, most frequently pelvic abscesses. Estimated 5-year survival was 18% for the total group. There was a statistically significant difference in survival and local re-recurrences between R0 / R1 and R2 stages. The results are discussed relative to recent studies. Patients in whom R0 resections can be achieved will benefit from the treatment, and probably patients with R1 resections would also benefit. Such operations should possibly be performed in specialised centres as joint ventures between various surgical subspecialities.

Preoperative irradiation and surgery for local recurrence of rectal and rectosigmoid cancer. Prognostic factors with regard to survival and further local recurrence

“…Thus the present study deals Figure 4 Kaplan-Meier plot of local recurrence of 124 R0 ⁄ R1-stage resected patients, total and each R-stage. Revised from [18].with kind permission by Springer Science and Business Media. Revised from [18] with kind permission by Springer Science and Business Media.…”

“…In a previous report we have presented our results of 193 patients operated for locally recurrent rectal cancer, including patients with known distant metastases at the time of operation [18].…”

Positive lymph node retrieval ratio optimises patient staging in colorectal cancer

“…39 Furthermore, the risk of pelvic recurrence is higher in patients with rectal cancer compared to those with colon cancer, and locally recurrent rectal cancer has frequently been associated with a poor prognosis. 40,41 Careful patient selection with respect to particular treatment options and the use of sequenced multimodality therapy for selected patients which combines chemoradiation (chemoRT) with operative treatment as part of the treatment regimen is recommended.…”

Irradiation with and without Razoxane in the Treatment of Incompletely Resected or Inoperable Recurrent Rectal Cancer

“…The reasons for that seem not to be related to surgery for recurrence. As a rule, only curative resections with clear margins (R0 resections) are associated with a substantial survival gain [21,37,38,40], but R0 resections were not included in this study. One reason is probably the wider use of recent salvage chemotherapy regimens including 5-FU continuous infusion, oxaliplatin and irinotecan, although bevazicumab or combinations of the newer drugs [24,31,32] were not yet applied in arm A or B.…”