Patterns of pelvic recurrence following definitive resections of rectal cancer

Abstract

Patterns of local and distant recurrences following resections for rectal cancer provide clinical perspective for multidisciplinary prevention and follow‐up programs. From 1968 to 1976 at Memorial Hospital, 412 patients with potentially curable rectal cancer were treated by anterior (AR) or abdominoperineal (APR) resections. First sites of recurrences were categorized as pelvis, liver, distant viscera, and intraabdominal/ retroperitoneal sites. Pelvic recurrences were further evaluated according to the location of the tumor, type of resection, and stage of disease. Among the 412 cases, 182 (44.2%) patients developed recurrence, of which 105 (57.6%) were pelvic. Pelvic recurrence was the predominating site either alone (55 of 103) or with concomitant extra‐pelvic sites (50/79). In instances of single‐site first recurrence, pelvic failure was recognized earliest at 19.1 months, which was significantly earlier than single‐distant visceral sites at 34.9 months. Pelvic recurrence was selectively related to various categories of the Dukes and modified Dukes staging systems. Dukes stage significantly predicted pelvic recurrence rates for Dukes A versus B. Astler‐Coller stages of B2 and C1 were associated with significantly lower rates of pelvic recurrence (29.7% and 22.1%, respectively) than C2 cancers. The incidence of pelvic recurrence was significantly increased for low and mid rectal cancers as compared with cancers at or above 12 cm. The type of resection utilized (APR versus AR) was associated with no difference in the rate of pelvic recurrence, except for the few patients in whom AR was performed for low rectal Dukes C cancers. Patients with pelvic recurrence had an ultimate disease‐free survival of only 3.8% as compared with patients with no pelvic recurrence of whom 77% remained alive without disease or went on to die of other causes. The timing and predominance of pelvic failure in rectal cancer with its own treatment‐related morbidity and overall dismal survival outcome justifies organized multidisciplinary efforts to prevent such failure and prospective trials of comprehensive follow‐up programs to evaluate improved cure rates or palliation. Cancer 53:1354‐1362, 1984.

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.…”

Microscopic spread of low rectal cancer in regions of mesorectum: Pathologic assessment with whole-mount sections

“…Therefore, we support a safe DMR resection margin of no less than 4 cm for lower rectal cancer, and consider that failure to adequate excision of the involved DRM would risk in leaving behind residual microscopic cancer foci in a significant percentage of patients. The most common pattern of pelvic recurrence is extramural diseases emanating from the sacral hollow or pelvic floor, which is entirely compatible with this hypothesis [24] . But others argued that pathological evidence of DMR spread in itself did not necessarily justify total removal of DMR in all cases because the local recurrence rate and survival rate were not improved significantly even after TME [4,17] .…”

Evaluation of the lateral sentinel node by indocyanine green for rectal cancer based on micrometastasis determined by reverse transcriptase-polymerase chain reaction

“…One of the most common sites of recurrence after a curative resection of rectal cancer is the pelvis (22) and local control is a major goal of surgical treatment. Appropriate dissection in order to eliminate residual cancer foci, such as any involved LNs, is therefore necessary to achieve local control.…”

“…Micrometastasis is generally evaluated by IHC or RT-PCR. Several investigators have emphasized the significance of LN micrometastasis as diagnosed by RT-PCR in colorectal cancer (CRC) (20,22). In Table I.…”