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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2015

01-12-2015 | Colorectal Cancer

Preoperative Chemoradiation Followed by Extensive Pelvic Surgery Improved the Outcome of Posterior Invasive Locally Recurrent Rectal Cancer without Deteriorating Surgical Morbidities: A Retrospective, Single-Institution Analysis

Authors: Hisataka Ogawa, MD, Mamoru Uemura, MD, PhD, Junichi Nishimura, MD, PhD, Taishi Hata, MD, PhD, Masakazu Ikenaga, MD, PhD, Ichiro Takemasa, MD, PhD, Tsunekazu Mizushima, MD, PhD, Masataka Ikeda, MD, PhD, Mitsugu Sekimoto, MD, PhD, Hirofumi Yamamoto, MD, PhD, Yuichiro Doki, MD, PhD, Masaki Mori, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2015

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Abstract

Purpose

The main feature of locally recurrent rectal cancer (LRRC) is infiltrating growth; thus, preoperative chemoradiation therapy (preCRT) is recommended to improve patient outcomes. However, no studies have reported the potential impact of preCRT on oncological and surgical outcomes in posterior invasive LRRC (piLRRC) that requires sacrectomy.

Methods

Forty-one patients with piLRRC were treated with (n = 25) or without (n = 16) preCRT. Oncological outcomes regarding local re-recurrence-free survival, distant metastasis-free survival, and overall survival (OS) were analyzed. Surgical complications were assessed using the Clavien–Dindo scale.

Results

The preCRT group had higher 5-year local re-recurrence-free survival (24.4 vs. 0 %) and OS (46.6 vs. 29.3 %) than the non-preCRT group. Univariate analysis demonstrated that preCRT (p = 0.03) and microlymphatic involvement (p = 0.01) were significantly related to local re-recurrence. Microlymphatic involvement occurred less frequently in the preCRT group than in the non-preCRT group (23.8 vs. 71.4 %; p = 0.01) despite the similarity in primary cancers between groups. Major infectious complications occurred with similar frequency in the preCRT and non-preCRT groups (24 vs. 18.8 %, p = 1).

Conclusions

PreCRT significantly benefited oncological outcome without compromising surgical results for piLRRC.
Literature
1.
Gunderson LL, Nelson H, Martenson JA, et al. Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Dis Colon Rectum. 1996;39(12):1379–95.CrossRefPubMed
2.
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(1):34–37.CrossRefPubMed
3.
Hida JI, Okuno K, Tokoro T. Distal dissection in total mesorectal excision, and preoperative chemoradiotherapy and lateral lymph node dissection for rectal cancer. Surg Today. 2014;44(12):2227–42.CrossRefPubMed
4.
Bozzetti F, Bertario L, Rossetti C, et al. Surgical treatment of locally recurrent rectal carcinoma. Dis Colon Rectum. 1997;40(12):1421–24.CrossRefPubMed
5.
Milne T, Solomon MJ, Lee P, Young JM, Stalley P, Harrison JD. Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg. 2013;258(6):1007–13.CrossRefPubMed
6.
Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg. 1994;220(4):586–95; discussion 595–7.PubMedCentralCrossRefPubMed
7.
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(12):2047–53; discussion 2053–4.CrossRefPubMed
8.
Hahnloser D, Nelson H, Gunderson LL, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg. 2003;237(4):502–8.PubMedCentralPubMed
9.
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(8):1078–84.CrossRefPubMed
10.
Dresen RC, Gosens MJ, Martijn H, et al. Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol. 2008;15(7):1937–47.PubMedCentralCrossRefPubMed
11.
Akasu T, Yamaguchi T, Fujimoto Y, et al. Abdominal sacral resection for posterior pelvic recurrence of rectal carcinoma: analyses of prognostic factors and recurrence patterns. Ann Surg Oncol. 2007;14(1):74–83.CrossRefPubMed
12.
Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2007;14(2):447–54.CrossRefPubMed
13.
14.
Uemura M, Ikeda M, Sekimoto M, et al. Prevention of severe pelvic abscess formation following extended radical surgery for locally recurrent rectal cancer. Ann Surg Oncol. 2009;16(8):2204–10.CrossRefPubMed
15.
Uemura M, Ikeda M, Yamamoto H, et al. Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence. Ann Surg Oncol. 2011;18(4):1015–22.CrossRefPubMed
16.
Lybeert ML, Martijn H, de Neve W, Crommelin MA, Ribot JG. Radiotherapy for locoregional relapses of rectal carcinoma after initial radical surgery: definite but limited influence on relapse-free survival and survival. Int J Radiat Oncol Biol Phys. 1992;24(2):241–6.CrossRefPubMed
17.
Uemura M, Ikeda M, Sekimoto M, et al. The features of late local recurrences following curative surgery for rectal cancer. Hepatogastroenterology. 2012;59(118):1800–03.PubMed
18.
Homma Y, Hamano T, Otsuki Y, Shimizu S, Kobayashi Y. The total number of lymph node metastases is a more significant risk factor for poor prognosis than positive lateral lymph node metastasis. Surg Today. 2015;45(2):168–74.CrossRefPubMed
19.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.PubMedCentralCrossRefPubMed
20.
Maetani S, Nishikawa T, Iijima Y, et al. Extensive en bloc resection of regionally recurrent carcinoma of the rectum. Cancer. 1992;69(12):2876–83.CrossRefPubMed
21.
Wanebo HJ, Antoniuk P, Koness RJ, et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum. 1999;42(11):1438–48.CrossRefPubMed
22.
Vermaas M, Ferenschild FT, Verhoef C, et al. Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. Eur J Surg Oncol. 2007;33(4):452–8.CrossRefPubMed
23.
Benson AB 3rd, Choti MA, Cohen AM, et al. NCCN practice guidelines for colorectal cancer. Oncology (Williston Park). 2000;14(11A):203–12.PubMed
24.
Yarnold J, Brotons MC. Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol. 2010;97(1):149–61.CrossRefPubMed
25.
26.
Marijnen CA, Glimelius B. The role of radiotherapy in rectal cancer. Eur J Cancer. 2002;38(7):943–52.CrossRefPubMed
27.
Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg. 2006;244(5):758–63.PubMedCentralCrossRefPubMed
28.
Heriot AG, Byrne CM, Lee P, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum. 2008;51(3):284–91.CrossRefPubMed
29.
Bosset JF, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results–EORTC 22921. J Clin Oncol. 2005;23(24):5620–27.CrossRefPubMed
30.
Minsky BD, Mies C, Rich TA, Recht A, Chaffey JT. Potentially curative surgery of colon cancer: the influence of blood vessel invasion. J Clin Oncol. 1988;6(1):119–27.PubMed
31.
Ouchi K, Sugawara T, Ono H, et al. Histologic features and clinical significance of venous invasion in colorectal carcinoma with hepatic metastasis. Cancer. 1996;78(11):2313–17.CrossRefPubMed
32.
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(5):585–92.CrossRefPubMed
33.
Melton GB, Paty PB, Boland PJ, et al. Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. Dis Colon Rectum. 2006;49(8):1099–107.CrossRefPubMed
34.
Dozois EJ, Privitera A, Holubar SD, et al. High sacrectomy for locally recurrent rectal cancer: Can long-term survival be achieved? J Surg Oncol. 2011;103(2):105–9.CrossRefPubMed
35.
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(7):988–93.CrossRefPubMed
Metadata
Title
Preoperative Chemoradiation Followed by Extensive Pelvic Surgery Improved the Outcome of Posterior Invasive Locally Recurrent Rectal Cancer without Deteriorating Surgical Morbidities: A Retrospective, Single-Institution Analysis
Authors
Hisataka Ogawa, MD
Mamoru Uemura, MD, PhD
Junichi Nishimura, MD, PhD
Taishi Hata, MD, PhD
Masakazu Ikenaga, MD, PhD
Ichiro Takemasa, MD, PhD
Tsunekazu Mizushima, MD, PhD
Masataka Ikeda, MD, PhD
Mitsugu Sekimoto, MD, PhD
Hirofumi Yamamoto, MD, PhD
Yuichiro Doki, MD, PhD
Masaki Mori, MD, PhD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4452-0

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