Locally Recurrent Rectal Cancer: Toward a Second Chance at Cure? A Population-Based, Retrospective Cohort Study

Abstract

Background In current practice, rates of locally recurrent rectal cancer (LRRC) are low due to the use of the total mesorectal excision (TME) in combination with various neoadjuvant treatment strategies. However, the literature on LRRC mainly consists of single- and multicenter retrospective cohort studies, which are prone to selection bias. The aim of this study is to provide a nationwide, population-based overview of LRRC after TME in the Netherlands. Patients and Methods In total, 1431 patients with nonmetastasized primary rectal cancer diagnosed in the first six months of 2015 and treated with TME were included from the nationwide, population-based Netherlands Cancer Registry. Data on disease recurrence were collected for patients diagnosed in these 6 months only. Competing risk cumulative incidence, competing risk regression, and Kaplan–Meier analyses were performed to assess incidence, risk factors, treatment, and overall survival (OS) of LRRC. Results Three-year cumulative incidence of LRRC was 6.4%; synchronous distant metastases (LRRC-M1) were present in 44.9% of patients with LRRC. Distal localization, R1–2 margin, (y)pT3-4, and (y)pN1-2 were associated with an increased LRRC rate. No differences in LRRC treatment and OS were found between patients who had been treated with or without prior n(C)RT. Curative-intent treatment was given to 42.9% of patients with LRRC, and 3-year OS thereafter was 70%. Conclusions Nationwide LRRC incidence was low. A high proportion of patients with LRRC underwent curative-intent treatment, and OS of this group was high in comparison with previous studies. Additionally, n(C)RT for primary rectal cancer was not associated with differences in treatment and OS of LRRC.

Comparison of prognosis for locally advanced T4b rectal cancer with different pelvic compartment involvement treated using neoadjuvant chemoradiotherapy and implications for refinement of the current TNM staging system

“…And the prognosis for patients with recurrent pelvic disease is poor. According to a recent published literature, the mean survival time was only 23.9 months for locally recurrent rectal cancer patients with prior neoadjuvant radiotherapy [22]. For those who undergone curative-intent treatment, the 3-year OS was 70%; For those who received palliative treatment or best supportive care, the 3-year OS was only 10-20% [22].…”

Management of patients with locally recurrent rectal cancer with a previous history of distant metastases: retrospective cohort study

“…Two recent studies demonstrated that 5.6–6.4% of rectal cancer patients experience local recurrence during their follow-up and up to 41–44.9% of these patients have metastases 11 , 12 . Excluding patients with known distant metastases, approximately 30% of patients with LRRC have indeterminate lung nodules observed at diagnosis 13 .…”

Laparoscopic resection for locally recurrent rectal cancer—a video vignette

“…Dear Editor, Locally recurrent rectal cancer (LRRC) occurs in 4%-11% of patients receiving curative treatment for primary rectal cancer [1,2]. For some patients with LRRC, there remains the possibility of further radical surgery and the ability to achieve a complete resection is paramount to ensure optimal patient outcomes.…”

“…For some patients with LRRC, there remains the possibility of further radical surgery and the ability to achieve a complete resection is paramount to ensure optimal patient outcomes. Previous research has reported that curative treatment and margin-free resection confers a survival advantage [2,3]. With complex pelvic anatomy, extent of tumour growth, fibrosis etc.…”

“…Parastomal hernias are more frequent in terminal colostomies, and only one-third of patients undergo surgery due to their elevated recurrence rate. Therefore, the best solution is its prevention [2].…”