Pelvic local recurrence from colorectal cancer: surgical challenge with changing preconditions

Iversen, Henrik; Johansson, Hemming; Nilsson, Per J.; Holm, Torbjörn

doi:10.1111/codi.13966

Cited by 37 publications

(28 citation statements)

References 20 publications

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“…In recent years, there has been a trend towards centralization of the management of patients with LRRC, which will probably lead to an increase in both the overall resection rate and the proportion of R0 resections. In the present study, an R0 resection was achieved in only 45·0 per cent of patients who underwent tumour resection, compared with R0 resection rates of up to 77 per cent in specialized centres. Although selection bias cannot be excluded when comparing different reports, it is highly likely that increasing surgical skills and greater experience from higher patient volumes improve R0 resection rates and oncological outcomes.…”

Section: Discussionmentioning

confidence: 53%

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Westberg

Palmer

Hjern

et al. 2019

British Journal of Surgery

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Background: Population-based studies of treatment of locally recurrent rectal cancer (LRRC) are lacking. The aim was to investigate the surgical treatment of patients with LRRC at a national population-based level.Methods: All patients undergoing abdominal resection for primary rectal cancer between 1995 and 2002 in Sweden with LRRC as a first event were included. Detailed information about treatment, complications and outcomes was collected from the medical records. The patients were analysed in three groups: patients who had resection of the LRRC, those treated without tumour resection and patients who received best supportive care only.Results: In all, 426 patients were included in the study. Of these, 149 (35⋅0 per cent) underwent tumour resection, 193 (45⋅3 per cent) had treatment without tumour resection and 84 (19⋅7 per cent) received best supportive care. Abdominoperineal resection was the most frequent surgical procedure, performed in 65 patients (43⋅6 per cent of those who had tumour resection). Thirteen patients had total pelvic exenteration. In total, 63⋅8 per cent of those whose tumour was resected had potentially curative surgery. After tumour resection, 62 patients (41⋅6 per cent) had a complication within 30 days. Patients who received surgical treatment without tumour resection had a lower complication rate but a significantly higher 30-day mortality rate than those who underwent tumour resection (10 versus 1⋅3 per cent respectively; P = 0⋅002). Of all patients included in the study, 22⋅3 per cent had potentially curative treatment and the 3-year survival rate for these patients was 56 per cent.Conclusion: LRRC is a serious condition with overall poor outcome. Patients undergoing curative surgery have an acceptable survival rate but substantial morbidity. There is room for improvement in the management of patients with LRRC.

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Section: Discussionmentioning

confidence: 53%

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Westberg

Palmer

Hjern

et al. 2019

British Journal of Surgery

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“…Meanwhile, R0 resection was still the only independent favorable factor for PFS among the variables related to LRRC, and this result is consistent with that of other recent reports. 21,22 Resection of LRRC impacts QoL by removing the symptom-producing lesion. In turn, getting longer PFS is to some degree linked to longer symptom-free survival.…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes after isolated local recurrence of rectal cancer and risk analysis affecting its resectability

Park

Lee

Han

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: This study aimed to investigate the clinical course and prognostic factors after isolated local recurrence (iLR) and to identify the predictive factors for R0 resection of locally recurrent rectal cancer (LRRC). Methods: We retrospectively reviewed the medical records of 76 patients with iLR who had undergone radical surgery for a primary tumor from 2003 to 2015. Results: The iLR rate was 2.5%. From 76 patients, 39 patients underwent R0 resection for iLR. Multivariate analysis revealed that initial open surgery, neoadjuvant chemoradiation, and p/ypT ≥ 3 were poor prognostic factors after iLR as regard to the variables related to the primary tumor; and symptom presence at the time of iLR diagnosis, higher fixity, and no chemotherapy after iLR were associated with shorter overall survival after iLR, and R0 resection of LRRC was the only favorable prognostic factor for progression-free survival after iLR as regard to the variables related to LRRC. Higher tumor level, negative pathologic circumferential margin of the primary tumor, and low fixity of LRRC were favorable factors in achieving R0 resection of LRRC. Conclusions: Early detection of iLR before symptom development, use of chemotherapy after iLR and R0 resection of LRRC should be considered to improve survival outcomes after iLR.

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“…With the implementation of high-quality TME, there has been a gradual shift from central recurrence (in the anastomosis site and perineum) to non-central recurrence; an increased proportion of recurrences have been found to be occurring in the presacral area and the lateral pelvic wall (16)(17)(18). The presacral plane is the most easily dissected plane during surgery and is almost always included in radiotherapy.…”

Section: Timing and Risk Factors Of Local Recurrencementioning

confidence: 99%

“…The proximity to the pelvic bone and major neurovascular structures means that achieving a complete resection and negative margin is technically challenging. Thus, the lateral recurrence type has a poor prognosis (18). Austin et al (54) reported a new approach for the en-bloc resection of pelvic sidewall structures, including the internal iliac vessels, piriformis and obturator internus muscles, ischium, sacrotuberous and sacrospinous ligaments.…”

Section: Multi-organ Excisionmentioning

confidence: 99%

Surgical treatment of locally recurrent rectal cancer: a narrative review

Gao¹,

Gu²

2021

Ann Transl Med

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Objective: To summarize the recent literature on surgical treatment of locally recurrent rectal cancer (LRRC).Background: LRRC is a heterogeneous disease that requires a multidisciplinary treatment approach. The treatment and prognosis depend on the site and type of recurrence. Radical resection remains the primary method for achieving long-term survival and improving symptom control. Preoperative chemoradiotherapy can reduce tumor volume and improve the R0 resection rate. Surgeons must clearly understand pelvic anatomy, develop a detailed preoperative plan, adopt a multidisciplinary approach for the surgical resection of the tumor as well as any invaded soft tissues, vessels, and bones, and ensure proper reconstruction.However, extended radical surgery often leads to a higher risk of postoperative complications and a low quality of life.Methods: We searched English-language articles with keywords "locally recurrent rectal cancer", "surgery" and "multidisciplinary team" in PubMed published between January 2000 to October 2020. Conclusions: LRRC is a complex problem. Long-term survival is not impossible following multidisciplinary treatment in appropriately selected LRRC patients. The management of LRRC relies on a specialist team that determines the biological behavior of the tumor and evaluates treatment options through multidisciplinary discussions, thereby balancing the surgical costs and benefits, alleviating postoperative complications, and improving patients' quality of life.

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Pelvic local recurrence from colorectal cancer: surgical challenge with changing preconditions

Cited by 37 publications

References 20 publications

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Survival outcomes after isolated local recurrence of rectal cancer and risk analysis affecting its resectability

Surgical treatment of locally recurrent rectal cancer: a narrative review

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