Factors predicting recurrence after curative resection for rectal cancer: a 16-year study

Farhat, Waad; Mohamed, Abdelrahman; Mizouni, Abdelkader; Ammar, Houssem; Ltaifa, Mahdi ben; Lagha, Sami; Kahloul, Mohamed; Gupta, Rahul; Mabrouk, Mohamed Ben; Ali, Ali Ben

doi:10.1186/s12957-019-1718-1

Cited by 29 publications

(33 citation statements)

References 30 publications

(38 reference statements)

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“…One of the most important risk factors for local recurrence is the severity of disease at the time of an initial operations [ 26 , 27 ]. Over half of patients with p/ypT4N2 in our series did not have local recurrence after primary tumor treatment (42.9%).…”

Section: Discussionmentioning

confidence: 99%

Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

et al. 2021

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Background and Objectives: Despite advances in treatment, local recurrence remains a great concern in patients with rectal cancer. The aim of this study was to investigate the incidence and risk factors of local recurrence of rectal cancer in our single center over a 7-year-period. Materials and Methods: Patients with stage I-III rectal cancer were treated with curative intent. The necessity for radiotherapy and chemotherapy was determined before surgery and/or postoperative histopathological results. Results: Of 365 rectal cancer patients, 76 (20.8%) developed recurrent disease. In total, 27 (7.4%) patients presented with a local tumor recurrence (isolated in 40.7% of cases). Radiotherapy was performed in 296 (81.1%) patients. The most often used schema was 5 × 5 Gy followed by immediate surgery (n = 214, 58.6%). Local recurrence occurred less frequently in patients treated with 5 × 5 Gy radiotherapy followed by surgery (n = 9, 4%). Surgical procedures of relapses were performed in 12 patients, six of whom were operated with radical intent. Only two (7.4%) patients lived more than 5 years after local recurrence treatment. The incidence of local recurrence was associated with primary tumor distal location and worse prognosis. The median overall survival of patients after local recurrence treatment was 19 months. Conclusions: Individualized rectal cancer patient selection and systematic treatment algorithms should be used clinical practice to minimize likelihood of relapse. 5 × 5 Gy radiotherapy followed by immediate surgery allows good local control in resectable cT2N+/cT3N0 patients. Radical resection of isolated local recurrence offers the best chances of cure.

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Section: Discussionmentioning

confidence: 99%

Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

et al. 2021

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“…None of them individually has provided reliable prognostic utility and there is a paucity of data investigating the effect of regional location on possible risk factors. Some of the variables correlated with higher risk of recurrence include a distal margin <2 cm, lymph node involvement, tumour stenosis, lymphovascular invasion and higher stage 5,6 . Other factors such as perforation and uncertain or non‐radical surgical procedures have been flagged as significant predictors for local recurrence 7 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for recurrence in colorectal cancer: a retrospective analysis in a regional Australian hospital

Holt

Schwalb

Elbourne

et al. 2021

ANZ Journal of Surgery

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Background Colorectal cancer is the third most commonly diagnosed malignancy in Australia. Up to a third of patients who have undergone surgery with curative intent for colorectal cancer will have a recurrence of disease leading to significant morbidity and mortality. Regional Australians have disproportionately worse outcomes. Aim To identify factors associated with recurrence in colorectal cancer patients treated at a regional Australian hospital. Methods This study is a retrospective cohort analysis. Consecutive patients who have undergone curative resection at a regional public and private hospital by three surgeons from a single surgical practice for either rectal cancer or colon cancer were included. Prognostic indicators of recurrence were examined via both univariate and multivariate time‐to‐event analyses. Results Three hundred nine patients were included with 43 recurrences. Thirty presented with distant metastases, seven presented with locoregional recurrence and six presented with locoregional as well as distant recurrence. In univariable analysis, higher rates of recurrence were associated with tumour type, higher AJCC summary stage, higher preoperative levels of CA19‐9, perineural invasion, lymphovascular invasion, <12 nodes examined, positive lymph nodes and emergency surgery status. On multivariable analysis recurrence remained associated with tumours with a mucinous and/or signet cell component, positive nodes and <12 lymph nodes examined. Conclusion A combination of patient and treatment factors are relevant in determining the risk of recurrence for stage I–III colorectal cancer. This study emphasises the importance of histology in determining risk, particularly the number of nodes examined. CEA 19–9 may also be a useful pre‐operative predictor of recurrence.

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“…In most cases, colorectal LRs are localized outside the anastomosis [ 22 – 25 ], which may suggest a use for diagnosis imaging method, such as CT colonography [ 23 ]. Fuccio et al [ 26 ] showed in the meta-analysis that the incidence of intraluminal LR in rectal cancer is 2 times higher than that in colon cancer.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study

et al. 2021

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Background Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis. Methods We performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR. Results During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy. Conclusions The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.

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Factors predicting recurrence after curative resection for rectal cancer: a 16-year study

Cited by 29 publications

References 30 publications

Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

Risk factors for recurrence in colorectal cancer: a retrospective analysis in a regional Australian hospital

Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study

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