Surgery for recurrent rectal cancer: technical notes and management of complications

Mirnezami, Alex H.; Sagar, P. M.

doi:10.1007/s10151-010-0585-0

Cited by 26 publications

(21 citation statements)

References 33 publications

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“…[21][22][23] Cerrahi veya palyasyon bu durumda standart tedavi kabul edilirken [7,8,24] genellikle uygunlanabilir bir yöntem değildir. [25] Daha önce EBRT alsın ya da almasın bu hastalar için SBRT bir seçenek olarak gö-rülmektedir. [20] Dört SBRT tedavisi uygulanan vaka serimizde iki hastada kıs-mi cevap bir hasta da tam cevap elde edildi.…”

Section: Discussionunclassified

“…[26][27][28] Bununla birlikte cerrai sonrası mortalite ve morbidite oranları sıra-sıyla %10 ve %50 gibi yüksek oranlardadır. [25,29] Pelvik lenf nodu nüks tedavisinde stereotaktik beden radyoterapisi seçenek olabilir mi? Akciğer R0 rezeksiyon mümkün olmadığında reküren veya oligometastatik bir durumda kemoterapi veya EBRT palyatif yarar sağlayabilmektedir.…”

Section: Discussionunclassified

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Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Dağoğlu¹

2015

TJ Oncol

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KliNiK ÇalIŞma ORIGINAL ARTICLE oBJeCtIVeSWhen surgery is not adequate, stereotactic body radiotherapy (SBRT) has been used for recurrent cancers. We report the outcomes of case series with pelvic recurrences from colorectal cancer irradiated with SBRT. metHoDSRobotic Stereotactic Radiotherapy system was used. The dose fractionation scheme was individualized based on tumor volume and location and prior radiation dose. reSultSBetween February 2010 and December 2014, four patients were treated. Treatment regions were pelvic side wall for two patients and presacral for two patients. SBRT doses were 24 Gy in 3 fractions for three patients and 36.25 Gy in 5 fractions for one patient.One patient treated for pelvic side wall recurrence developed symptomatic noropathy at fist year. CoNCluSIoNLocal recurrence in pelvis after modern combined modality treatment for colorectal cancer is rare. However it presents a therapeutic dilemma when it occurs; often symptomatic and eventually life threatening. SBRT can be a useful modality in this setting.

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Section: Discussionunclassified

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Dağoğlu¹

2015

TJ Oncol

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“…A reasonable method to assess the haemorrhage risk is to attempt a trial dissection and to have a low threshold for sacrectomy. As an individual surgeon gains experience with sacrectomies, the intra-operative blood loss can be minimized by resecting the sacrum en bloc with the attached presacral venous plexus[19]. …”

Section: Surgical Approach Based On Location Of Diseasementioning

confidence: 99%

“…Perineal and sacral defects can be quite extensive after en bloc sacral resection of the tumour recurrence. Primary closure may be achieved without tension and may be reinforced with a biological mesh[19,42,58,59]. Alternatively, there are various myocutaneous flaps that can be used for soft tissue reconstruction, as discussed above.…”

Section: Surgical Approach Based On Location Of Diseasementioning

confidence: 99%

“…These centres are exploring new techniques in order to improve the likelihood of adequate oncological resection. Due to this peaked interest in LRRC, previously deemed contraindications[19] (Table 1) are now proven by certain specialized centres to be feasible and safe for so called “ultra-radical resection[15]”. In addition, improved reconstructive techniques allow for better functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Lee

Sagar

Sadadcharam

et al. 2017

WJG

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Locally recurrent rectal cancer (LRRC) is a complex disease with far-reaching implications for the patient. Until recently, research was limited regarding surgical techniques that can increase the ability to perform an en bloc resection with negative margins. This has changed in recent years and therefore outcomes for these patients have improved. Novel radical techniques and adjuncts allow for more radical resections thereby improving the chance of negative resection margins and outcomes. In the past contraindications to surgery included anterior involvement of the pubic bone, sacral invasions above the level of S2/S3 and lateral pelvic wall involvement. However, current data suggests that previously unresectable cases may now be feasible with novel techniques, surgical approaches and reconstructive surgery. The publications to date have only reported small patient pools with the research conducted by highly specialised units. Moreover, the short and long-term oncological outcomes are currently under review. Therefore although surgical options for LRRC have expanded significantly, one should balance the treatment choices available against the morbidity associated with the procedure and select the right patient for it.

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Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Westberg

Palmer

Hjern

et al. 2019

British Journal of Surgery

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Background: Population-based studies of treatment of locally recurrent rectal cancer (LRRC) are lacking. The aim was to investigate the surgical treatment of patients with LRRC at a national population-based level.Methods: All patients undergoing abdominal resection for primary rectal cancer between 1995 and 2002 in Sweden with LRRC as a first event were included. Detailed information about treatment, complications and outcomes was collected from the medical records. The patients were analysed in three groups: patients who had resection of the LRRC, those treated without tumour resection and patients who received best supportive care only.Results: In all, 426 patients were included in the study. Of these, 149 (35⋅0 per cent) underwent tumour resection, 193 (45⋅3 per cent) had treatment without tumour resection and 84 (19⋅7 per cent) received best supportive care. Abdominoperineal resection was the most frequent surgical procedure, performed in 65 patients (43⋅6 per cent of those who had tumour resection). Thirteen patients had total pelvic exenteration. In total, 63⋅8 per cent of those whose tumour was resected had potentially curative surgery. After tumour resection, 62 patients (41⋅6 per cent) had a complication within 30 days. Patients who received surgical treatment without tumour resection had a lower complication rate but a significantly higher 30-day mortality rate than those who underwent tumour resection (10 versus 1⋅3 per cent respectively; P = 0⋅002). Of all patients included in the study, 22⋅3 per cent had potentially curative treatment and the 3-year survival rate for these patients was 56 per cent.Conclusion: LRRC is a serious condition with overall poor outcome. Patients undergoing curative surgery have an acceptable survival rate but substantial morbidity. There is room for improvement in the management of patients with LRRC.

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Surgery for recurrent rectal cancer: technical notes and management of complications

Cited by 26 publications

References 33 publications

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

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