Systematic review of classification systems for locally recurrent rectal cancer

Abstract

Background Classification of pelvic local recurrence (LR) after surgery for primary rectal cancer is not currently standardized and optimal imaging is required to categorize anatomical site and plan treatment in patients with LR. The aim of this review was to evaluate the systems used to classify locally recurrent rectal cancer (LRRC) and the relevant published outcomes. Methods A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE and CENTRAL databases. The primary outcome was to review the classifications currently in use; the secondary outcome was the extraction of relevant information provided by these classification systems including prognosis, anatomy and prediction of R0 after surgery. Results A total of 21 out of 58 eligible studies, classifying LR in 2086 patients, were reviewed. Studies used at least one of the following eight classification systems proposed by institutions or institutional groups (Mayo Clinic, Memorial Sloan-Kettering – original and modified, Royal Marsden and Leeds) or authors (Yamada, Hruby and Kusters). Negative survival outcomes were associated with increased pelvic fixity, associated symptoms of LR, lateral compared with central LR and involvement of three or more pelvic compartments. A total of seven studies used MRI with specifically defined anatomical compartments to classify LR. Conclusion This review highlights the various imaging systems in use to classify LRRC and some of the prognostic indicators for survival and oncological clearance based on these systems. Implementation of an agreed classification system to document pelvic LR consistently should provide more detailed information on anatomical site of recurrence, burden of disease and standards for comparative outcome assessment.

Correlation of Presacral Tumour Recurrence with Tumour Metastasis and Long-Term Tumour Recurrence Risk in Patients with Rectal Cancer

“…Patients with presacral tumour recurrence will not only suffer unbearable pain due to the influence on bone structure but also face higher treatment difficulty, which seriously compromise their quality of life [13]. Local recurrence of RC always increases the difficulty of treatment for patients, and recurrence in different parts often causes different tumour metastasis, long-term recurrence, and prognosis [14,15]. However, at present, there is no reliable assessment method for the prognosis and recurrence of CR, and corresponding preventive measures are lacking.…”

Short-term results after robot-assisted surgery for primary rectal cancers requiring beyond total mesorectal excision in multiple compartments

“…Surgical procedures were retrospectively classified (by EBT and AMS) according to which pelvic compartments were resected, using the compartmental classification proposed by the Royal Marsden group. 13,14 Briefly, this MRI-based classification divides the pelvis into seven compartments along fascia boundaries and anatomical planes amenable to surgical dissection, with each compartment containing specific pelvic structures and organs (Fig. 1).…”

“…To accurately report the extent of the bTME resections, surgery was, in addition, classified according to pelvic compartments resected, using the compartmental classification developed for magnetic resonance imaging (MRI) in preoperative planning suggested by the Royal Marsden group. 13,14…”

Hypofractionated radiotherapy combined with chemotherapy and Toripalimab for locally recurrent rectal cancer: a single-arm, phase II trial (TORCH-R)

“…Despite these advancements, 4-10% of patients still develop pelvic recurrence [1][2][3] with or without extra pelvic metastases, especially in cases that did not receive standard initial treatment. It can lead to signi cant morbidity, with severe local symptoms including pelvic pain, bleeding and obstruction [4,5].…”