Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum

Adloff, M; Arnaud, Jean‐Pierre; Schloegel, M.; Thibaud, Dominique

doi:10.1007/bf02560227

Cited by 59 publications

(18 citation statements)

References 14 publications

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“…Though the local recurrence rate of 9.6% in the period 1991–1993 seems higher than 7% in the period 1994–1997, the mean follow-up period is shorter in the latter group. Since 87% of the tumours have recurred within 2 years in this study, which is, in accordance with the literature [22, 23], the anticipated local recurrence rate for the period 1994–1997 is unlikely to be significantly different from the period 1991–1993.…”

Section: Discussionsupporting

confidence: 77%

The Implications of Subspecialisation on the Management and Outcome of Surgery for Rectal Carcinoma

Warsi

Woodward²,

Stock³

et al. 2002

Dig Surg

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Background: The management of rectal carcinoma has changed significantly over the last decade. We studied the changing trends in the management of rectal carcinoma over a 7-year period in a district general hospital. Methods: A retrospective analysis of all patients with histologically proven rectal adenocarcinoma who underwent operative treatment between January 1991 and December 1997 was performed. The type of operative procedure, local recurrence rate and completeness of pathology reporting was documented. Results: There were 200 operative procedures: 102 anterior resections (AR), and 98 abdominoperineal resections (APR). This included 17 palliative resections because of metastatic disease (n = 8) or extensive local invasion (n = 7) or both (n = 2). The APR rate steadily declined from 72% in 1991 to 19% in 1997 (p < 0.005). Subspecialist ‘colorectal’ surgeons performed only 24% of the operations in 1991 but the figure for 1997 was 85% (p < 0.01). No circumferential resection margin was reported in 1991 but was reported in 85% of the cases in 1997 (p < 0.001). There was a steady increase in stapled anastomoses from 43% in 1991 to 93% in 1997 (p < 0.03). There were 15 local recurrences following ‘curative’ resection; 7 following APR and 8 following AR (n.s.). Conclusion: There was a significant increase in the rate of restorative resection of rectal cancer with a concomitant reduction in permanent stoma formation; this may be attributed to an increase in subspecialisation. Despite this, a low rate of local recurrence was maintained throughout the study period.

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Section: Discussionsupporting

confidence: 77%

The Implications of Subspecialisation on the Management and Outcome of Surgery for Rectal Carcinoma

Warsi

Woodward²,

Stock³

et al. 2002

Dig Surg

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“…It has been found that the locoregional failure increases as the stage of the disease increases. 14 Invasion into other organs and perforation of the bowel due to cancer are also strongly associated with locoregional failure. 15 Patient and tumor factors also need to be assessed.…”

Section: Predictive Factors For Recurrencementioning

confidence: 99%

“…Leaving behind positive margins, whether grossly or microscopically involved, carries absolutely no advantage over no therapy at all. 13,14 As in primary rectal carcinoma, multimodal therapy has been shown to increase resectability rates, improve the rate of obtaining disease-free margins, and increase overall survival. Combined modality therapy results in local control rates in the range of 30 to 85%.…”

Section: Surgery For Recurrent Rectal Cancermentioning

confidence: 99%

Reoperation for Recurrent Colorectal Cancer

Hellinger

Santiago

2006

Clinics in Colon and Rectal Surgery

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Recurrence of colorectal carcinoma represents a significant challenge. As the majority of recurrences involve more than just the anastomosis, surgical resection is ordinarily a major undertaking. Curative resection may require resection of other organs and structures, resulting in complex reconstructive procedures and substantial morbidity. In addition, carefully selected patients with distant metastases to sites such as the liver and lungs may also undergo potentially curative resection. Long-term survival following curative surgery for recurrence, however, ranges from only 15 to 40%. In addition to resection for curative intent, some patients may benefit from palliative procedures designed to relieve symptoms. Surgery alone is not usually sufficient therapy in these patients. Chemotherapy and radiation therapy play a vital adjunctive role in the management of recurrent disease. This article strives to review the risk factors and patterns of recurrence, selection of individuals for resection of recurrent disease, and outcomes of surgical procedures. KEYWORDS: Colorectal neoplasm, recurrence, surgery, metastaticObjectives: Upon completion of this article, the reader should be able to summarize the risk factors for and patterns of recurrence in colon and rectal cancer and summarize the indications, procedures, and outcomes for surgery of recurrent colorectal cancer.

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“…Up to 5% of the patients with T1 adenocarcinomas have been found to have microscopic perirectal lymph node involvement, and patients with T2 primary will have a 10-27% chance of insidious lymph node metastasis [25,26]. In fact, lymph node metastasis was detected in case 2 in this series.…”

Section: Discussionmentioning

confidence: 59%

Invagination Method with Diagonal Resection of the Anal Canal for Cancer of the Lower Rectum

Tanigawa¹,

Horiuchi²,

Shimomatsuya³

et al. 1993

Dig Surg

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If the length of the remaining anal canal after surgery is not adequate, various problems with defecation can occur. With the purpose of preserving the anal canal as much as possible, a new attempt was made in patients with distal rectal cancer in whom the anal canal would be resected when the usual sphincter-sparing operation is applied. The novelty of this technique is that, when the invaginated technique of the Maunsell-Weir method is performed, the everted anal canal in the perineum is resected diagonally to permit preservation of a maximum length of the anal canal. Anastomoses with the diagonal rectal stump prohibit strictures, which frequently occur upon colo-anal anastomosis. Indications for this procedure include: the low region, at a distance less than 4 cm from the dentate line; less than T2 for mural stage, and less than one third the circumference for size. Four patients, in whom this technique was sequentially performed 3 years ago, were favorably reviewed according to various aspects such as tumor size, site, mural stage, lymph node metastasis, postoperative urination/defecation function, and stool soilage. We believe that this method should be the operation of choice in selected patients with low rectal cancer.

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Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum

Cited by 59 publications

References 14 publications

The Implications of Subspecialisation on the Management and Outcome of Surgery for Rectal Carcinoma

The Implications of Subspecialisation on the Management and Outcome of Surgery for Rectal Carcinoma

Reoperation for Recurrent Colorectal Cancer

Invagination Method with Diagonal Resection of the Anal Canal for Cancer of the Lower Rectum

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