Prognostic factors in surgery for local recurrence of rectal cancer

Gagliardi, G.; Hawley, P. R.; Hershman, M. J.; Arnott, S.J.

doi:10.1002/bjs.1800821035

Cited by 68 publications

(47 citation statements)

References 23 publications

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“…The St. Mark’s group found four factors associated with longer survival: radical nature of the operation, absence of severe symptoms, a recurrent tumor <5 cm in diameter, and CEA level <5 ng/ml; however, tumor diameter was the only independent prognostic factor [23]. Wanebo et al [15]reported that patients with previous APR and CEA levels >10 ng/ml had a worse 5-year survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies report the role of early detection of local recurrence in resectability and prognosis after resection [15, 23, 24, 25]. The St. Mark’s group found four factors associated with longer survival: radical nature of the operation, absence of severe symptoms, a recurrent tumor <5 cm in diameter, and CEA level <5 ng/ml; however, tumor diameter was the only independent prognostic factor [23].…”

Section: Discussionmentioning

confidence: 99%

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Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

et al. 2003

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Background/Aims: Local pelvic recurrence of rectal cancer after radical resection has been associated with morbidity and cancer-related death. This study retrospectively evaluated outcome following curative resection for rectal cancer recurring after surgery on the basis of prognosis, type of procedure and perioperative morbidity. Methods: A total of 85 consecutive patients with local pelvic recurrence of rectal cancer were evaluated. Of these, 43 underwent microscopic curative surgery for local recurrence. Among the 43 patients, 23 underwent surgery alone and 17 received preoperative radiotherapy (40 Gy) (XRT group) in addition to the surgery. Of the 43 patients, 26 were asymptomatic. Results: Curative resection was higher in the recurrences that were associated with implantation, incomplete surgical margin clearance, and intrapelvic lymph node metastasis than in other types of recurrence. With regard to surgical procedure, abdominoperineal resection (APR), with or without sacral resection, was standard following previous sphincter-preserving surgery, while total pelvic exenteration (TPE), with or without sacral resection, was common following previous APR. Local excision was not considered appropriate surgery. There was a high incidence of perioperative morbidity (64%) in patients receiving TPE. Re-recurrence was observed in 18 patients (50%) after curative surgery. After a follow-up of 2 years or more, the local re-recurrence rate was 28%. The overall 5-year survival rate for patients receiving curative resection was 39%, for patients in the XRT group, 51%, and for patients in the surgery-alone group, 24% (p = 0.07). The survival rate in 26 asymptomatic patients was higher than in 17 patients with symptoms, with 5-year survival rates of 62 and 23% (p < 0.05), respectively. The cumulative local control in the preoperative radiotherapy plus en bloc surgery group (XRT group) was significantly better than in the surgery-alone group (p < 0.01), and survival in the XRT group tended to be better than in surgery alone. Conclusions: These results suggest that careful patient selection according to the pattern of recurrence, area of invasion and presence of symptoms is important for successful curative surgery. Aggressive surgery with adjuvant therapy may lead to an improved salvage rate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

et al. 2003

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“…Therefore, these invasive procedures should only be considered in carefully selected patients. Although significant prognostic factors influencing the outcome of surgery for local recurrence have been identified, such as postoperative tumor marker levels and pathological curativity of surgical margins [17, 18], recognizable factors after surgery are not useful in determining the indications for surgery. As a result, factors which can be found preoperatively must be identified.…”

Section: Introductionmentioning

confidence: 99%

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Noura¹,

Ohue²,

Seki³

et al. 2008

Dig Surg

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Background: Patients undergoing a curative rectal cancer resection have a risk of developing locoregional recurrence. A curative resection for local recurrence is the option of improvement in prognosis. However, a curative resection is sometimes too invasive and should be considered in selected patients. Methods: A total of 43 patients with locally recurrent rectal cancer who had been treated by operation between 1989 and 2007 were retrospectively reviewed and the factors, including doubling time of carcinoembryonic antigen (CEA-dt), were analyzed. Results: The 5-year overall survival rate after the operation for local recurrence was 50.8%. Gender, presence of distant metastasis, tumor size, CEA-dt and curability were found to be significant prognostic factors. A multivariate analysis demonstrated the presence of distant metastasis, CEA-dt and tumor size to be significant prognostic factors for overall survival. The 5-year overall survival rates of patients with a CEA-dt ≧150 days and a tumor size <5 cm were 76.9%. Conclusions: The tumor size and CEA-dt were useful prognostic factors that were recognizable before surgery. Patients with locally recurrent rectal cancer with a CEA-dt ≧150 days and a recurrent tumor size <5 cm are considered to be good candidates for surgery.

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“…Radiotherapy dose was specified in 28 studies. [3][4][5][6][7][8][9]11,18,19,28,29,30,[33][34][35][36][37]41,44,46,47,[50][51][52][53]56,57 Without prior EBRT, the total dose was 40-60 Gy in most studies, with an overall range of 15-80 Gy. Conventional fractionation (1.8-2.0 Gy per fraction) was uniformly applied in 13 studies, 3,6,7,9,11,18,19,28,30,36,46,50,52 and selective use of a hypofractionated schedule (fractions of 5 Gy) was described in 2 studies.…”

Section: Perioperative Treatment For Local Recurrencementioning

confidence: 99%

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

Tanis

Doeksen

Lanschot

2013

cjs

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic reviewBackground: There is a lack of outcome data beyond local recurrence rates after primary treatment in rectal cancer, despite more information being necessary for clinical decision-making. We sought to determine patient selection, therapeutic modalities and outcomes of locally recurrent rectal cancer treated with curative intent. Methods:We searched MEDLINE (1990-2010) using the medical subject headings "rectal neoplasms" and "neoplasm recurrence, local." Selection of cohort studies was based on the primary intention of treatment and availability of at least 1 outcome variable. Results:We included 55 cohort studies comprising 3767 patients; 8 studies provided data on the rate of intentionally curative treatment from an unselected consecutive cohort of patients (481 of 1188 patients; 40%). Patients were symptomatic with pain in 50% (796 of 1607) of cases. Overall, 3088 of 3767 patients underwent resection. The R0 resection rate was 56% (1484 of 2637 patients). The rate of external beam radiotherapy was 100% in 9 studies, 0% in 5 studies, and ranged from 12% to 97% in 37 studies. Overall postoperative mortality was 2.2% (57 of 2515 patients). Five-year survival was at least 25%, with an upper limit of 41% in 11 of 18 studies including at least 50 resections. We found a significant increase in reported survival rates over time (r 2 = 0.214, p = 0.007). Conclusion:More uniformity in treatment protocols and reporting on outcomes for locally recurrent rectal cancer is warranted. The observed improvement of reported survival rates in time is probably related to better patient selection and optimized multimodality treatment in specialized centres.

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Prognostic factors in surgery for local recurrence of rectal cancer

Cited by 68 publications

References 23 publications

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

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