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Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO) RAPIDO collaborative investigators; Bahadoer

SummaryMany aspects of bilateral presentation or recurrence of reflex sympathetic dystrophy (RSD) are unknown. For this reason 1183 consecutive patients with RSD were analyzed. In 10 patients RSD started in symmetrical limbs. In 34 patients RSD recurred in the same limb after a period of no or few complaints and in 76 patients RSD recurred in one or more limbs other than the first limb. Compared to 1065 patients with RSD without these features, these patients were younger (P < 0.01) and RSD started more frequently with a cold skin temperature (P = 0.02). Patients did not differ in gender or primary localization of RSD. Involvement of a second limb concerned in 47% the symmetrical limb. Recurrences were in 53% of spontaneous origin and often characterized by few signs and symptoms. The incidence of a recurrence was 1.8% per patient per year. No measures are known to prevent recurrence. Reflex sympathetic dystrophy may recur in the same or in another limb, although only in a minority of patients. Recurrences occur especially in younger patients and in the symmetrical limb. Diagnosis of a recurrence is difficult, for often the recurrence is spontaneous and presents with few signs and symptoms.

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