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Long-term surveillance of locally advanced rectal cancer patients with neoadjuvant chemoradiation and aggressive surgical treatment of recurrent disease: a consecutive single-centre experience

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to analyse the long-term outcome of rectal cancer patients who submitted to preoperative chemoradiation with consecutive intensive follow-up and aggressive surgical treatment of recurrent disease.

Methods

Patients with locally advanced (cT3-4 Nx M0-1) mid/low rectal cancer were treated at a tertiary university hospital with preoperative long-course chemoradiation followed by resection (according to a prospective study protocol). After resection, all patients were urged to participate in a standardised, risk-independent intensive follow-up program. All curatively treated patients (n = 153, 96 %) were included in our long-term analysis with respect to curative re-resection of recurrent disease.

Results

Of 153 patients, 143 (93 %) participated in our follow-up program: 63 % were surveyed longer than 5 years after primary therapy (mean follow-up 75 months, 95 % CI 67.8–82.2). Fifty-five (36 %) patients developed cancer recurrence (mean 27.8 months, 95 % CI 20.6–34.9, range 3–108), giving a disease-free survival rate of 68.5 and 60.7 % at 5 and 10 years; 21 (38 %) patients were re-resected curatively and 58 (38 %) patients died during the observation period, giving an overall survival rate of 70.8 and 57.5 % at 5 and 10 years. Multivariate analysis found tumour differentiation (P < 0.01), operative procedure (P < 0.05) and downstaging (P < 0.01) to be independent variables influencing overall survival.

Conclusions

The combination of multimodal therapy and aggressive surgical treatment of metastases including repeated re-resections in curative intention is relevant in order to chronify the disease. Thus, both intensive and extended follow-up beyond 5 years appear to be mandatory.

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Acknowledgments

We are indebted to Mary Heaney Margreiter for professional native-speaker editing of this manuscript.

Conflicts of interest

There is no conflict of interest.

Funding

No funding was received for this study from any organization.

All authors approved this manuscript.

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Authors and Affiliations

  1. Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria

    Matthias Zitt, Reinhold Kafka-Ritsch & Dietmar Öfner

  2. Department of Radiotherapy-Radiooncology, Innsbruck Medical University, Innsbruck, Austria

    Alexander DeVries & Peter Lukas

  3. Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria

    Josef Thaler & Wolfgang Eisterer

  4. Department of Radiooncology, Feldkirch Hospital, Feldkirch, Austria

    Alexander DeVries

  5. Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria

    Josef Thaler

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  1. Matthias Zitt
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  2. Alexander DeVries
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Correspondence to Matthias Zitt.

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Zitt, M., DeVries, A., Thaler, J. et al. Long-term surveillance of locally advanced rectal cancer patients with neoadjuvant chemoradiation and aggressive surgical treatment of recurrent disease: a consecutive single-centre experience. Int J Colorectal Dis 30, 1705–1714 (2015). https://doi.org/10.1007/s00384-015-2366-8

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  • DOI: https://doi.org/10.1007/s00384-015-2366-8

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