Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

Abstract

Background/Aims: Local pelvic recurrence of rectal cancer after radical resection has been associated with morbidity and cancer-related death. This study retrospectively evaluated outcome following curative resection for rectal cancer recurring after surgery on the basis of prognosis, type of procedure and perioperative morbidity. Methods: A total of 85 consecutive patients with local pelvic recurrence of rectal cancer were evaluated. Of these, 43 underwent microscopic curative surgery for local recurrence. Among the 43 patients, 23 underwent surgery alone and 17 received preoperative radiotherapy (40 Gy) (XRT group) in addition to the surgery. Of the 43 patients, 26 were asymptomatic. Results: Curative resection was higher in the recurrences that were associated with implantation, incomplete surgical margin clearance, and intrapelvic lymph node metastasis than in other types of recurrence. With regard to surgical procedure, abdominoperineal resection (APR), with or without sacral resection, was standard following previous sphincter-preserving surgery, while total pelvic exenteration (TPE), with or without sacral resection, was common following previous APR. Local excision was not considered appropriate surgery. There was a high incidence of perioperative morbidity (64%) in patients receiving TPE. Re-recurrence was observed in 18 patients (50%) after curative surgery. After a follow-up of 2 years or more, the local re-recurrence rate was 28%. The overall 5-year survival rate for patients receiving curative resection was 39%, for patients in the XRT group, 51%, and for patients in the surgery-alone group, 24% (p = 0.07). The survival rate in 26 asymptomatic patients was higher than in 17 patients with symptoms, with 5-year survival rates of 62 and 23% (p < 0.05), respectively. The cumulative local control in the preoperative radiotherapy plus en bloc surgery group (XRT group) was significantly better than in the surgery-alone group (p < 0.01), and survival in the XRT group tended to be better than in surgery alone. Conclusions: These results suggest that careful patient selection according to the pattern of recurrence, area of invasion and presence of symptoms is important for successful curative surgery. Aggressive surgery with adjuvant therapy may lead to an improved salvage rate.

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

“…[3][4][5][6][7][8][9]11,18,19,28,29,30,[33][34][35][36][37]41,44,46,47,[50][51][52][53]56,57 Without prior EBRT, the total dose was 40-60 Gy in most studies, with an overall range of 15-80 Gy. Conventional fractionation (1.8-2.0 Gy per fraction) was uniformly applied in 13 studies, 3,6,7,9,11,18,19,28,30,36,46,50,52 and selective use of a hypofractionated schedule (fractions of 5 Gy) was described in 2 studies. 34 described the use of re-EBRT, 7 of which specified the rate.…”

A exenteração pélvica para o câncer de reto: avaliação dos fatores prognósticos de sobrevida em 27 pacientes operados

“…Hazard Ratio (95% CI) P Em que pese à alta morbidade da exenteração pélvica, essa é a única oportunidade de controle da doença em longo prazo, haja vista que os demais tratamentos têm apresentado resultados desalentadores (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

“…Estima-se que entre 6 e 10% de todas as neoplasias retais se encontrem no estádio T4 no momento de seu diagnóstico (1)(2)(3). Por outro lado, as recidivas pélvicas após cirurgia potencialmente curativa têm variado de 4 a 50% (4)(5)(6)(7)(8). Somente a ressecção cirúrgica completa (R0) e em monobloco, interessando tanto a neoplasia quanto os órgãos adjacentes comprometidos, pode oferecer real possibilidade de controle da doença em longo prazo nessa situação clínica (1,2,4,(7)(8)(9)(10).…”

“…Em contrapartida, para os doentes nessa mesma situação clínica não ressecados e submetidos a tratamento exclusivo com quimioterapia e radioterapia, a sobrevida em 5 anos não atinge 5% (5,6,8).…”

“…Cerca de 0% a 23% dos doentes mesmo após uma ressecção R0 alcançam 5 anos de sobrevida global (2,11,15,16). Apesar dos resultados pouco expressivos, esse tipo de operação tem demonstrado controle duradouro dos sintomas nessa população levando assim a um benefício paliativo relevante (5,8,15).…”