Outcome After Curative Resection for Locally Recurrent Rectal Cancer

Abstract

Approximately two-thirds of patients with locally recurrent rectal cancer can be resected for cure. Preoperative carcinoembryonic antigen and an R0 resection margin were the only significant predictors of overall survival. p53, bcl-2, and ki-67 did not impact survival outcomes.

Prediction of Residual Disease or Distant Metastasis After Resection of Locally Recurrent Rectal Cancer

“…On the other hand, the majority of patients with recurrence after resection for LRRC developed extrapelvic disease before or at the time of resection. 9,12,13 In the present study, which is the first to analyze prognostic predictors of systemic failure after treatment, the distant disease-free survival curve had a steep decline within one year after resection, indicating a high frequency of residual or subclinical DISEASES OF THE COLON & RECTUM VOLUME 53: 5 (2010) metastatic disease outside the pelvis in patients with isolated LRRC. It is essential to predict failure patterns accurately in patients with treatable LRRC so that appropriate therapy can be selected as an adjunct to extensive surgery for the local recurrence.…”

“…Marginal (R1) resections with positive microscopic margins were performed for 20 patients, and incomplete (R2) resections with gross residual disease were performed for 19 patients. Eighteen patients (17.8%) with suspected or confirmed microscopic residual disease in the pelvis received intraoperative radiotherapy (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). When the outcome of frozen sections taken during surgery was positive with macroscopic or gross residual disease, external beam radiotherapy (45-50 Gy) was delivered postoperatively in 41 patients (40.6%).…”

“…However, these advantages are tempered by the high incidence of postoperative complications and the early development of a second distant recurrence. 9,[11][12][13] Without complete resection (R0), these patients have a short life expectancy 7,9,[12][13][14][15][16][17][18] and tend to experience unpleasant symptoms, especially pain, and their quality of life becomes extremely poor. 19 The patients who present with metastatic disease soon after a curative resection of their local recurrence may experience delays in systemic treatment secondary to complications from surgery.…”

Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica

“…Apesar deste fato, o envolvimento da margem distal de ressecção está associado à recidiva local, sendo considerado a principal causa mencionada em algumas séries na literatura. (25,26,27,28) A taxa de ressecabilidade nas cirurgias para recidiva pélvica foi de 65,4%, próximo ao encontrado por Bedrosin e col. (29) , que verificaram aproximadamente 60% de ressecabilidade nestes casos, e superior ao referido por Boyle e col. (7) , (36,8%).…”

Pre-Operative Staging with Positron Emission Tomography in Patients with Pelvic Recurrence of Rectal Cancer

“…Downsizing by neo-adjuvant (chemo)radiotherapy is recommended if possible [reviewed in [1]]. The 3-year survival rate after successful treatment of locally recurrent rectal cancer has been estimated to be between 30 and 60% in retrospective series, with local tumour control in 30–75% of the patients at 3 years [2, 3]. Resection of a local recurrence is a major pelvic procedure and carries a high morbidity rate and a mortality risk of up to 10% [2].…”