Skip to main content
Top
Published in: Diseases of the Colon & Rectum 3/2008

01-03-2008 | Original Contribution

Extended Radical Resection: The Choice for Locally Recurrent Rectal Cancer

Authors: Alexander G. Heriot, M.D., F.R.C.S., F.R.A.C.S, Christopher M. Byrne, M.S., F.R.A.C.S, Peter Lee, F.R.A.C.S, Bruce Dobbs, M.D., Henry Tilney, M.R.C.S, Michael J. Solomon, M.Sc., F.R.A.C.S, John Mackay, F.R.A.C.S, Frank Frizelle, M.M.Sci., F.R.A.C.S

Published in: Diseases of the Colon & Rectum | Issue 3/2008

Login to get access

Abstract

Purpose

Surgery for recurrent rectal cancer is the only therapy with curative potential. This study was designed to assess factors that affect survival after surgery for locally recurrent rectal cancer.

Methods

Prospective databases of patients undergoing surgical resection for recurrent rectal cancer at three tertiary centers between 1990 and 2006 were combined and analyzed. Cox regression and Kaplan-Meier survival analysis were used to assess factors associated with survival.

Results

A total of 160 patients (96 males) underwent surgery (median age, 63 (range, 27–93) years). Ninety-five patients (59 percent) received neoadjuvant radiotherapy. Sixty-three patients (39 percent) underwent radical resection and 90 (56 percent) underwent extended radical resection. Seven patients (5 percent) were irresectable. There was one death and 27 percent had major postoperative complications, independent of extent of resection. Negative resection margins were obtained in 98 patients (R0 61 percent). Median cancer-specific and overall survival was 48 months (41.5 percent 5-year survival) and 43 months (36.6 percent 5-year survival), respectively. Margin involvement was a significant predictor of cancer-specific (P < 0.001) and overall survival (P < 0.02).

Conclusions

Resection for recurrent rectal cancer results in good survival with acceptable morbidity, unaffected by the extent of resection. Extended radical resection to obtain clear resection margins is the appropriate management of locally recurrent rectal cancer.
Literature
1.
go back to reference Ruo L, Guillem J. Major 20th-Century advances in the management of rectal cancer. Dis Colon Rectum 1999;42:563–78.PubMedCrossRef Ruo L, Guillem J. Major 20th-Century advances in the management of rectal cancer. Dis Colon Rectum 1999;42:563–78.PubMedCrossRef
2.
go back to reference Heriot A, Kumar D. Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2000;2:126–37.CrossRef Heriot A, Kumar D. Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2000;2:126–37.CrossRef
3.
go back to reference Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following "curative surgery" for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.PubMedCrossRef Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following "curative surgery" for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.PubMedCrossRef
4.
go back to reference Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer. Br J Surg 1996;83:293–304.PubMedCrossRef Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer. Br J Surg 1996;83:293–304.PubMedCrossRef
5.
go back to reference Ito K, Ohtsu A, Ishikura S, et al. Efficacy of chemoradiotherapy on pain relief in patients with intrapelvic recurrence of rectal cancer. Jpn J Clin Oncol 2003;33:180–5.PubMedCrossRef Ito K, Ohtsu A, Ishikura S, et al. Efficacy of chemoradiotherapy on pain relief in patients with intrapelvic recurrence of rectal cancer. Jpn J Clin Oncol 2003;33:180–5.PubMedCrossRef
6.
go back to reference Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum H, Hintz BL. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981;48:1492–5.PubMedCrossRef Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum H, Hintz BL. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981;48:1492–5.PubMedCrossRef
7.
go back to reference Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.PubMedCrossRef Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.PubMedCrossRef
8.
go back to reference McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–7.PubMedCrossRef McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–7.PubMedCrossRef
9.
go back to reference Dunphy J. Recurrent cancer of the colon and rectum: report of cases with favorable results following radical surgery. N Engl J Med 1947;237:111–3.CrossRefPubMed Dunphy J. Recurrent cancer of the colon and rectum: report of cases with favorable results following radical surgery. N Engl J Med 1947;237:111–3.CrossRefPubMed
10.
go back to reference Heriot A, Tekkis P, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis 2006;8:733–47.PubMedCrossRef Heriot A, Tekkis P, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis 2006;8:733–47.PubMedCrossRef
11.
go back to reference Garcia-Aguilar J, Cromwell J, Marra C, Lee SH, Madoff R, Rothenberger D. Treatment of locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1743–8.PubMedCrossRef Garcia-Aguilar J, Cromwell J, Marra C, Lee SH, Madoff R, Rothenberger D. Treatment of locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1743–8.PubMedCrossRef
12.
go back to reference Lopez-Kostner F, Fazio V, Vignali A, Rybicki L, Lavery I. Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 2001;44:173–8.PubMedCrossRef Lopez-Kostner F, Fazio V, Vignali A, Rybicki L, Lavery I. Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 2001;44:173–8.PubMedCrossRef
13.
go back to reference Hahnloser D, Nelson H, Gunderson L, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003;237:502–8.PubMedCrossRef Hahnloser D, Nelson H, Gunderson L, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003;237:502–8.PubMedCrossRef
14.
go back to reference 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;47:2047–54.PubMedCrossRef 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;47:2047–54.PubMedCrossRef
15.
go back to reference Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995;19:59–71.PubMedCrossRef Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995;19:59–71.PubMedCrossRef
16.
go back to reference Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309–21.PubMedCrossRef Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309–21.PubMedCrossRef
18.
go back to reference Guillem J, Ruo L. Strategies in operative therapy for locally recurrent rectal cancer. Semin Colon Rectal Surg 1998;9:259–68. Guillem J, Ruo L. Strategies in operative therapy for locally recurrent rectal cancer. Semin Colon Rectal Surg 1998;9:259–68.
19.
go back to reference Moore H, Harrision L, Guillem J. Cancer of the rectum: follow-up and management of local recurrence. 2nd ed. In: Fazio VW, Church JM, Delaney CP, eds. Current therapy in colon and rectal surgery. Philadelphia: Elsevier Mosby, 2005:185–90. Moore H, Harrision L, Guillem J. Cancer of the rectum: follow-up and management of local recurrence. 2nd ed. In: Fazio VW, Church JM, Delaney CP, eds. Current therapy in colon and rectal surgery. Philadelphia: Elsevier Mosby, 2005:185–90.
20.
go back to reference Boyle K, Sagar P, Chalmers A, Sebag-Montefiore D, Cairns A, Eardley I. Surgery for locally recurrent rectal cancer. Dis Colon Rectum 2005;48:929–37.PubMedCrossRef Boyle K, Sagar P, Chalmers A, Sebag-Montefiore D, Cairns A, Eardley I. Surgery for locally recurrent rectal cancer. Dis Colon Rectum 2005;48:929–37.PubMedCrossRef
21.
go back to reference Suzuki K, Dozois RR, Devine RM, et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum 1996;39:730–6.PubMedCrossRef Suzuki K, Dozois RR, Devine RM, et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum 1996;39:730–6.PubMedCrossRef
22.
go back to reference Wiggers T, de Vries MR, Veeze-Kuypers B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum 1996;39:323–8.PubMedCrossRef Wiggers T, de Vries MR, Veeze-Kuypers B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum 1996;39:323–8.PubMedCrossRef
23.
go back to reference Bakx R, van Tinteren H, van Lanschot J, Zoetmulder F. Surgical treatment of locally recurrent rectal cancer. Eur J Surg Oncol 2004;30:857–63.PubMed Bakx R, van Tinteren H, van Lanschot J, Zoetmulder F. Surgical treatment of locally recurrent rectal cancer. Eur J Surg Oncol 2004;30:857–63.PubMed
24.
go back to reference Bedrosian I, Giacco G, Pederson L, et al. Outcome after curative resection for locally recurrent rectal cancer. Dis Colon Rectum 2006;49:175–82.PubMedCrossRef Bedrosian I, Giacco G, Pederson L, et al. Outcome after curative resection for locally recurrent rectal cancer. Dis Colon Rectum 2006;49:175–82.PubMedCrossRef
25.
go back to reference Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T. Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 2001;88:988–93.PubMedCrossRef Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T. Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 2001;88:988–93.PubMedCrossRef
26.
go back to reference Moore H, Shoup M, Riedel E, et al. Colorectal cancer pelvic recurrences: determination of resectability. Dis Colon Rectum 2004;47:1599–606.PubMedCrossRef Moore H, Shoup M, Riedel E, et al. Colorectal cancer pelvic recurrences: determination of resectability. Dis Colon Rectum 2004;47:1599–606.PubMedCrossRef
27.
go back to reference Mannaerts G, Rutten H, Martijn H, Hanssens P, Wiggers T. Comparison of intraoperative radiation therapy-containing multimodality treatment with historical treatment modalities for locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1749–58.PubMedCrossRef Mannaerts G, Rutten H, Martijn H, Hanssens P, Wiggers T. Comparison of intraoperative radiation therapy-containing multimodality treatment with historical treatment modalities for locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1749–58.PubMedCrossRef
28.
go back to reference Wiig J, Poulsen J, Tveit K, Olsen D, Giercksky K-E. Intra-operative irradiation (IORT) for primary advanced and recurrent rectal cancer: a need for randomised studies. Eur J Cancer 2000;36:868–74.PubMedCrossRef Wiig J, Poulsen J, Tveit K, Olsen D, Giercksky K-E. Intra-operative irradiation (IORT) for primary advanced and recurrent rectal cancer: a need for randomised studies. Eur J Cancer 2000;36:868–74.PubMedCrossRef
29.
go back to reference Wiig J, Tveit K, Poulsen J, Olsen D, Giercksky K-E. Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiother Oncol 2002;62:207–13.PubMedCrossRef Wiig J, Tveit K, Poulsen J, Olsen D, Giercksky K-E. Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiother Oncol 2002;62:207–13.PubMedCrossRef
30.
go back to reference Watson A, Lolohea S, Robertson G, Frizelle F. The role of positron emission tomography in the management of recurrent colorectal cancer: a review. Dis Colon Rectum 2007;50:1–13.CrossRef Watson A, Lolohea S, Robertson G, Frizelle F. The role of positron emission tomography in the management of recurrent colorectal cancer: a review. Dis Colon Rectum 2007;50:1–13.CrossRef
31.
go back to reference Messiou C, Chalmers A, Boyle K, Sagar P. Surgery for recurrent rectal carcinoma: the role of preoperative magnetic resonance imaging. Clin Radiol 2006;61:250–8.PubMedCrossRef Messiou C, Chalmers A, Boyle K, Sagar P. Surgery for recurrent rectal carcinoma: the role of preoperative magnetic resonance imaging. Clin Radiol 2006;61:250–8.PubMedCrossRef
Metadata
Title
Extended Radical Resection: The Choice for Locally Recurrent Rectal Cancer
Authors
Alexander G. Heriot, M.D., F.R.C.S., F.R.A.C.S
Christopher M. Byrne, M.S., F.R.A.C.S
Peter Lee, F.R.A.C.S
Bruce Dobbs, M.D.
Henry Tilney, M.R.C.S
Michael J. Solomon, M.Sc., F.R.A.C.S
John Mackay, F.R.A.C.S
Frank Frizelle, M.M.Sci., F.R.A.C.S
Publication date
01-03-2008
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 3/2008
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-007-9152-9

Other articles of this Issue 3/2008

Diseases of the Colon & Rectum 3/2008 Go to the issue