Prognostic and predictive factors after surgical treatment for locally recurrent rectal cancer: A single institute experience

Asoğlu, Oktar; Karanlık, Hasan; Müslümanoğlu, Mahmut; İğci, Abdullah; Emek, Ertan; Özmen, Vahit; Keçer, Mustafa; Parlak, Mesut; Kapran, Yersu

doi:10.1016/j.ejso.2007.02.026

Cited by 63 publications

(60 citation statements)

References 37 publications

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“…A number of prognostic factors affecting survival after a surgical resection of a local recurrence of rectal cancer have been reported by many investigators, including maximum tumor size [17], interval between the primary surgery and surgery for recurrence [23], curability of the surgery for recurrence [24, 25], procedure of primary surgery [26, 27], absence of severe symptoms [28], fixity of the recurrent tumor [28], gender [29] and the preoperative serum CEA level [11, 27, 30]. However, the survival in relation to the prognostic factors varied among the institutions, and the factors which are the best indicators for a surgical resection remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Noura¹,

Ohue²,

Seki³

et al. 2008

Dig Surg

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Background: Patients undergoing a curative rectal cancer resection have a risk of developing locoregional recurrence. A curative resection for local recurrence is the option of improvement in prognosis. However, a curative resection is sometimes too invasive and should be considered in selected patients. Methods: A total of 43 patients with locally recurrent rectal cancer who had been treated by operation between 1989 and 2007 were retrospectively reviewed and the factors, including doubling time of carcinoembryonic antigen (CEA-dt), were analyzed. Results: The 5-year overall survival rate after the operation for local recurrence was 50.8%. Gender, presence of distant metastasis, tumor size, CEA-dt and curability were found to be significant prognostic factors. A multivariate analysis demonstrated the presence of distant metastasis, CEA-dt and tumor size to be significant prognostic factors for overall survival. The 5-year overall survival rates of patients with a CEA-dt ≧150 days and a tumor size <5 cm were 76.9%. Conclusions: The tumor size and CEA-dt were useful prognostic factors that were recognizable before surgery. Patients with locally recurrent rectal cancer with a CEA-dt ≧150 days and a recurrent tumor size <5 cm are considered to be good candidates for surgery.

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Section: Discussionmentioning

confidence: 99%

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Noura¹,

Ohue²,

Seki³

et al. 2008

Dig Surg

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“…Marginal (R1) resections with positive microscopic margins were performed for 20 patients, and incomplete (R2) resections with gross residual disease were performed for 19 patients. Eighteen patients (17.8%) with suspected or confirmed microscopic residual disease in the pelvis received intraoperative radiotherapy (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). When the outcome of frozen sections taken during surgery was positive with macroscopic or gross residual disease, external beam radiotherapy (45-50 Gy) was delivered postoperatively in 41 patients (40.6%).…”

Section: Treatment Of Recurrencementioning

confidence: 99%

“…However, these advantages are tempered by the high incidence of postoperative complications and the early development of a second distant recurrence. 9,[11][12][13] Without complete resection (R0), these patients have a short life expectancy 7,9,[12][13][14][15][16][17][18] and tend to experience unpleasant symptoms, especially pain, and their quality of life becomes extremely poor. 19 The patients who present with metastatic disease soon after a curative resection of their local recurrence may experience delays in systemic treatment secondary to complications from surgery.…”

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confidence: 99%

Prediction of Residual Disease or Distant Metastasis After Resection of Locally Recurrent Rectal Cancer

Kanemitsu¹,

Hirai²,

Kono³

et al. 2010

Diseases of the Colon &Amp; Rectum

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“…27,41,63 The 2 most important predictors of radical resection of local recurrence are previous anterior resection instead of APR and the absence of pain at the time of recurrence. 43,64,65 Intraluminal recurrences, especially after initial local excision, are separated from the bony pelvis and sacral nerves by remaining soft tissue, thereby not resulting in pain and enabling resection with adequate margins in almost all patients. 26,35,39 Given the worse outcome for local recurrence after prior APR, optimal primary treatment of distal cancers is of utmost importance.…”

Section: Discussionmentioning

confidence: 99%

“…The authors used several selection criteria based on type of treatment for primary rectal cancer, characteristics of local recurrence, type of treatment for local recurrence and intraoperative findings. In 8 studies, 9,13,16,20,[42][43][44]54 the total number of patients undergoing treatment with curative intent from an unselected consecutive cohort of patients could be determined: 481 of 1188 patients (40%). The median period of patient inclusion was 13.3 (range 3.9-34) years in 51 studies (Table 1).…”

Section: Description Of Selected Cohortsmentioning

confidence: 99%

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

Tanis

Doeksen

Lanschot

2013

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic reviewBackground: There is a lack of outcome data beyond local recurrence rates after primary treatment in rectal cancer, despite more information being necessary for clinical decision-making. We sought to determine patient selection, therapeutic modalities and outcomes of locally recurrent rectal cancer treated with curative intent. Methods:We searched MEDLINE (1990-2010) using the medical subject headings "rectal neoplasms" and "neoplasm recurrence, local." Selection of cohort studies was based on the primary intention of treatment and availability of at least 1 outcome variable. Results:We included 55 cohort studies comprising 3767 patients; 8 studies provided data on the rate of intentionally curative treatment from an unselected consecutive cohort of patients (481 of 1188 patients; 40%). Patients were symptomatic with pain in 50% (796 of 1607) of cases. Overall, 3088 of 3767 patients underwent resection. The R0 resection rate was 56% (1484 of 2637 patients). The rate of external beam radiotherapy was 100% in 9 studies, 0% in 5 studies, and ranged from 12% to 97% in 37 studies. Overall postoperative mortality was 2.2% (57 of 2515 patients). Five-year survival was at least 25%, with an upper limit of 41% in 11 of 18 studies including at least 50 resections. We found a significant increase in reported survival rates over time (r 2 = 0.214, p = 0.007). Conclusion:More uniformity in treatment protocols and reporting on outcomes for locally recurrent rectal cancer is warranted. The observed improvement of reported survival rates in time is probably related to better patient selection and optimized multimodality treatment in specialized centres.

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Prognostic and predictive factors after surgical treatment for locally recurrent rectal cancer: A single institute experience

Cited by 63 publications

References 37 publications

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Prediction of Residual Disease or Distant Metastasis After Resection of Locally Recurrent Rectal Cancer

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

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