Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial

Abstract

Aim of the study: In patients from the Dutch TME trial patterns of local recurrence (LR) in rectal cancer were studied. The purpose was to reconstruct the most likely mechanisms of LR and the effect of preoperative radiotherapy.Methods: 1417 patients were analyzed; 713 were randomized into preoperative radiotherapy and total mesorectal excision (RT+TME), 704 into TME alone. Of the 114 patients with LR, the subsites of LR were determined and related to tumor and treatment factors. Results:Overall 5-year LR-rate was 4.6% in the RT+TME group and 11.0% in the TME group.Presacral local recurrences occurred most in both groups. Radiotherapy reduced anastomotic LR significantly, except when after low anterior resection (LAR) distal margins were less than 5 mm.Abdominoperineal resection (APR) mainly resulted in presacral LR. Even after resection with a negative circumferential resection margin, LR rates were high. 30% of the patients had advanced tumors, which resulted in 58% of all LRs. Lateral LR comprised 20% of all LR. Presacral LR resulted in a poor prognosis, in contrast to anterior or anastomotic LRs with a relatively good prognosis. Conclusions:RT reduces LR in all subsites and is especially effective in preventing anastomotic LR after LAR. APR surgery mainly results in presacral LR, which may be prevented by a wider resection.In the TME trial many advanced tumors were included, rather requiring chemoradiotherapy in stead of RT. Currently, with good imaging techniques, better selection can take place. Especially lateral LR might be a problem in the future.

Отдаленные Результаты Хирургического И Комбинированного Лечения Больных Раком Верхнеампулярного Отдела Прямой Кишки

“…В иссле-дованиях отмечается значительная тенденция в пользу улучшения результатов в группах комбинированного лечения, но эти различия не достигли статистической достоверности. Кроме того, стоит отметить, что ни в одном из рандомизированных исследований прогно-стическая значимость таких показателей, как глубина инвазии и метастатическое поражение регионарных лимфатических узлов при верхнеампулярном раке, не была проанализирована [14,15]. В связи с этим нам показалось интересным изучить влияние различных клинико-морфологических факторов после химиолу-чевой терапии и хирургического лечения на возник-новение местных рецидивов, отдаленных метастазов и показатели 5-летней БРВ.…”

Detection of Free Cancer Cells in Pelvic Lavage with Double Immunocytochemistry at Rectal Cancer Surgery

“…The reported differences in local recurrence after rectal cancer surgery could be explained by differences in the populations studied, or in oncological and surgical strategies (17)(18)(19). A TME of poor quality with tears and defects in the MRF increases the risk of local recurrence (1).…”

Intensive Follow-Up After Curative Surgery for Colorectal Cancer

“…Our data is in line with previous studies that found metachronous lesions in 1.5 to 3% of patients in the first three to five years postoperatively and local recurrence occurs in less than 5% of patients with rectal cancer. [23][24][25][26][27][28][29][30][31][32][33][34] Early detection of recurrence in the asymptomatic phase in most patients allowed curative intent treatment strategies for more than one third of patients (n = 21, 40.3%). The pattern of recurrence was associated with the site of the primary tumor (p < 0.001).…”