Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2007

01-01-2007

Abdominal Sacral Resection for Posterior Pelvic Recurrence of Rectal Carcinoma: Analyses of Prognostic Factors and Recurrence Patterns

Authors: Takayuki Akasu, MD, Takashi Yamaguchi, MD, Yoshiya Fujimoto, MD, Seiji Ishiguro, MD, Seiichiro Yamamoto, MD, Shin Fujita, MD, Yoshihiro Moriya, MD

Published in: Annals of Surgical Oncology | Issue 1/2007

Login to get access

Abstract

Background

Local recurrence of rectal cancer presents challenging problems. Although abdominal sacral resection (ASR) provides pain control, survival prolongation, and possibly cure, reported morbidity and mortality are still high, and survival is still low. Thus, appropriate patient selection and adjuvant therapy based on prognostic factors and recurrence patterns are necessary. The purpose of this study was to evaluate the results of ASR for posterior pelvic recurrence of rectal carcinoma and to analyze prognostic factors and recurrence patterns.

Methods

Forty-four patients underwent ASR for curative intent in 40 and palliative intent in 4 cases. All but one could be followed up completely. Multivariate analyses of factors influencing survival and positive surgical margins were conducted.

Results

Morbidity and mortality were 61% and 2%, respectively. Overall 5-year survival was 34%. The Cox regression model revealed a positive resection margin (hazard ratio, 10 [95% confidence interval, 3.8–28]), a local disease–free interval of <12 months (4.2 [1.8–9.8]), and pain radiating to the buttock or further (4.2 [1.6–11]) to be independently associated with poor survival. The logistic regression model showed that macroscopic multiple expanding or diffuse infiltrating growths were independently associated with a positive margin (7.5 [1.4–40]). Of the patients with recurrence, 56% had failures confined locally or to the lung.

Conclusions

ASR is beneficial to selected patients in terms of survival. To select patients, evaluation of the resection margin, the local disease–free interval, pain extent, and macroscopic growth pattern is important. To improve survival, adjuvant treatment should be aimed at local and lung recurrences.
Literature
1.
Stearns MWJ. Diagnosis and management of recurrent pelvic malignancy following combined abdominoperineal resection. Dis Colon Rectum 1980; 23:359–61PubMedCrossRef
2.
Wanebo HJ, Whitehill R, Gaker D, Wang GJ, Morgan R, Constable W. Composite pelvic resection, an approach to advanced pelvic cancer. Arch Surg 1987; 122:1401–6PubMed
3.
Wanebo HJ, Koness RJ, Turk PS, Cohen SI. Composite resection of posterior pelvic malignancy. Ann Surg 1992; 215:685–95PubMedCrossRef
4.
Pearlman NW, Stiegmann GV, Donohue RE. Extended resection of fixed rectal cancer. Cancer 1989; 63:2438–41PubMedCrossRef
5.
Simmonds PC. Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis. Colorectal Cancer Collaborative Group. BMJ 2000; 321:531–5PubMedCrossRef
6.
7.
Hoffman JP, Riley L, Carp NZ, Litwin S. Isolated locally recurrent rectal cancer: a review of incidence, presentation, and management. Semin Oncol 1993;20:506–19PubMed
8.
Lingareddy V, Ahmad NR, Mohiuddin M. Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys 1997; 38:785–90PubMedCrossRef
9.
Wong CS, Cummings BJ, Brierley JD, et al. Treatment of locally recurrent rectal carcinoma: results and prognostic factors. Int J Radiat Oncol Biol Phys 1998; 40:427–35PubMedCrossRef
10.
Cohen AM, Minsky BD. Aggressive surgical management of locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 1990; 33:432–8PubMedCrossRef
11.
Wanebo HJ, Marcove RC. Abdominal sacral resection of locally recurrent rectal cancer. Ann Surg 1981; 194:458–71PubMedCrossRef
12.
Brunschwig A, Barber HR. Pelvic exenteration combined with resection of segments of bony pelvis. Surgery 1969; 65:417–20PubMed
13.
Wanebo HJ, Antoniuk P, Koness RJ, et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 1999; 42:1438–48PubMedCrossRef
14.
Maetani S, Onodera H, Nishikawa T, et al. Significance of local recurrence of rectal cancer as a local or disseminated disease. Br J Surg 1998; 85:521–13PubMedCrossRef
15.
Mannaerts GH, Rutten HJ, Martijn H, Groen GJ, Hanssens PE, Wiggers T. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum 2001; 44:806–14PubMedCrossRef
16.
Magrini S, Nelson H, Gunderson LL, Sim FH. Sacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer. Dis Colon Rectum 1996; 39:1–9PubMedCrossRef
17.
Hahnloser D, Nelson H, Gunderson LL, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003; 237:502–8PubMedCrossRef
18.
Pearlman NW, Stiegmann GV, Donohue RE. Extended resection of fixed rectal cancer. Cancer 1989; 63:2438–41PubMedCrossRef
19.
Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg 1986; 73:342–4PubMedCrossRef
20.
21.
Takagi H, Morimoto T, Hara S, Suzuki R, Horio S. Seven cases of pelvic exenteration combined with sacral resection for locally recurrent rectal cancer. J Surg Oncol 1986; 32:184–8PubMedCrossRef
22.
Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T. Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 2002; 45:1078–84PubMedCrossRef
23.
Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum 2004; 47:2047–53PubMedCrossRef
24.
Onodera H, Maetani S, Kawamoto K, Kan S, Kondo S, Imamura M. Pathologic significance of tumor progression in locally recurrent rectal cancer: different nature from primary cancer. Dis Colon Rectum 2000; 43:775–81PubMedCrossRef
25.
Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994; 220:586–95PubMedCrossRef
26.
Deckers PJ, Olsson C, Williams LA, Mozden PJ. Pelvic exenteration as palliation of malignant disease. Am J Surg 1976; 131:509–15PubMedCrossRef
27.
Cunningham JD, Enker W, Cohen A. Salvage therapy for pelvic recurrence following curative rectal cancer resection. Dis Colon Rectum 1997; 40:393–400PubMedCrossRef
28.
de Lange EE, Fechner RE, Wanebo HJ. Suspected recurrent rectosigmoid carcinoma after abdominoperineal resection: MR imaging and histopathologic findings. Radiology 1989; 170:323–8PubMed
29.
Farouk R, Nelson H, Radice E, Mercill S, Gunderson L. Accuracy of computed tomography in determining resectability for locally advanced primary or recurrent colorectal cancers. Am J Surg 1998; 175:283–7PubMedCrossRef
30.
Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 1999; 211:215–22PubMed
31.
Fletcher JG, Johnson CD, Krueger WR, et al. Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma. AJR Am J Roentgenol 2002; 178:283–90PubMed
32.
Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985; 312:1465–72CrossRef
33.
Påhlman L. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997; 336:980–7CrossRef
34.
Marijnen CA, Nagtegaal ID, Kapiteijn E, et al. Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys 2003; 55:1311–20PubMedCrossRef
35.
Shoup M, Guillem JG, Alektiar KM, et al. Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy. Dis Colon Rectum 2002; 45:585–92PubMedCrossRef
36.
Maetani S, Nishikawa T, Iijima Y, et al. Extensive en bloc resection of regionally recurrent carcinoma of the rectum. Cancer 1992; 69:2876–83 PubMedCrossRef
Metadata
Title
Abdominal Sacral Resection for Posterior Pelvic Recurrence of Rectal Carcinoma: Analyses of Prognostic Factors and Recurrence Patterns
Authors
Takayuki Akasu, MD
Takashi Yamaguchi, MD
Yoshiya Fujimoto, MD
Seiji Ishiguro, MD
Seiichiro Yamamoto, MD
Shin Fujita, MD
Yoshihiro Moriya, MD
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9082-0

Other articles of this Issue 1/2007

Annals of Surgical Oncology 1/2007 Go to the issue

OriginalPaper

Isolated Limb Perfusion With Melphalan and Tumor Necrosis Factor α for Advanced Melanoma and Soft-Tissue Sarcoma

OriginalPaper

Prognostic Indicators for Patients Undergoing Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Diffuse Malignant Peritoneal Mesothelioma†

OriginalPaper

Local Involvement of the Urinary Bladder in Primary Colorectal Cancer: Outcome with En-Bloc Resection

OriginalPaper

Risk Factors for Non-Sentinel Lymph Node Metastases in Patients with Breast Cancer. The Outcome of a Multi-institutional Study

OriginalPaper

The 2003 Revised TNM Staging System for Breast Cancer: Results of Stage Re-classification on Survival and Future Comparisons among Stage Groups

OriginalPaper

Stromal Osteonectin Overexpression Is Associated with Poor Outcome in Patients with Ampullary Cancer