Skip to main content

Advertisement

SpringerLink
Log in

Locally recurrent rectal cancer: Surgical strategy

  • World Progress In Surgery
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Relapses after “curative resection” of rectal cancer may be localized and thus amenable to surgical treatment. The risk of relapse may be higher than previously believed depending on adequacy and length of follow-up, the diagnostic modalities used, and the number of autopsies performed. Technical refinements such as a distal margin >2 cm, radical pelvic lymphadenectomy, and high ligation of the inferior mesenteric artery at the aorta do not appear to diminish the risk of recurrence. A wider lateral margin and a more complete excision of the mesorectum may be beneficial, but this is yet unproven. Surgery for isolated, locally recurrent lesions should be limited to carefully selected patients and performed in tertiary centers using a team approach. Whether such radical “salvage” procedures are justifiable merits further careful evaluation.

Résumé

La récidive après résection à visée “curatrice” d'un cancer rectal peut être locale et alors accessible à la chirurgie. Le risque de récidive est peut-être plus élevé qu'il n'est classique de le dire en raison des différences, à travers la littérature, du caractère complet et la durée de la surveillance, des modalités diagnostiques et du nombre d'autopsies pratiquées. Les détails techniques comme l'exérèse d'une marge distale supérieure à 2 cm, une lymphadénectomie pelvienne radicale, et la ligature haute de l'artère mésentérique au niveau de l'aorte ne paraissent pas diminuer le risque de récidive. La dissection latérale plus poussée et la résection du mésorectum peuvent être bénéfiques mais ceci reste à prouver. La chirurgie des lésions récidivées, isolées, doit être limitée à des patients sélectionnés, réalisées dans les centres spécialisés en profitant d'une approche multidisciplinaire. L'utilité de telles résections, dites de “sauvetage”, mérite d'être évaluée d'avantage.

Resumen

Los relapsos que ocurren después de resección “curativa” de un cáncer rectal puedun ser localizadas y, por consiguiente, susceptibles de tratamiento quirúrgico. El riesgo de relapso puede ser más alto de lo que previamente se creía, dependiendo de lo adecuado y lo prolongado del seguimiento, de las modalidades diagnósticas utilizadas y del número de autopsias realizadas. Los refinamientos técnicos tales como un margen distal mayor de 2 cm, linfadenectomía pélvica radical y ligadura alta de la arteria mesentérica inferior a nivel de la aorta no parecen disminuir el riesgo de recurrencia. Un margen lateral más amplio y una más completa resección del meso-recto pueden ser beneficiosos, pero ésto está todavía por probar. La cirugía para lesiones recurrentes locales aisladas debe limitarse a pacientes cuidadosamente seleccionados y a centros de atención de nivel terciario que enfoquen el problema en forma de equipo interdisciplinario. El interrogante sobre si tales procedimientos radicales de “salvamento” tienen justifición amerita mayor y meticulosa evaluación.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carlsson, U., Larson, A., Ekelund, G.: Recurrence rates after curative surgery for rectal cancer with special reference to their accuracy. Dis. Colon Rectum30:431, 1987

    PubMed  Google Scholar 

  2. Gunderson, L.L., Sosin, H.: Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy. Cancer34:1278, 1974

    PubMed  Google Scholar 

  3. Törnqvist, A., Ekelund, G., Leandoer, L.: The value of intensive follow-up after curative resection of colorectal carcinoma. Br. J. Surg.69:725, 1982

    PubMed  Google Scholar 

  4. Dozois, R.R., Perry, R.E.: Rectal cancer: Current management. Curr. Probl. Surg.28:243, 1990

    Google Scholar 

  5. Michelassi, F., Vannucci, L., Montag, A., Goldberg, R., Chappell, R., Dytch H., Bibbo, M., Block, G.E.: Importance of tumor morphology for the long term prognosis of rectal adenocarcinoma. Am. Surg.54:376, 1988

    PubMed  Google Scholar 

  6. Michelassi, F., Block, G.E., Vannucci, L., Montag, A., Chappell, R.: A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma. Ann. Surg.208:379, 1988

    PubMed  Google Scholar 

  7. Feil, W., Wunderlich, M., Kovats, E., Neuhold, N., Schemper, M., Wenzl, E., Schiessel, R.: Rectal cancer: Factors influencing the development of local recurrence after radical anterior resection. Int. J. Color. Dis.3:195, 1988

    Article  Google Scholar 

  8. Scott, N.A., Rainwater, L.M., Wieand, H.S., Weiland, L.H., Pemberton, J.H., Beart, R.W. Jr., Lieber, M.M.: The relative prognostic value of flow cytometric DNA analysis and conventional clinicopathologic criteria in patients with operable rectal carcinoma. Dis. Colon Rectum30:513, 1987

    PubMed  Google Scholar 

  9. Chang, K.J., Enker, W.E., Melamed, M.: Influence of tumor cell DNA ploidy on the natural history of rectal cancer. Am. J. Surg.153:184, 1987

    Article  PubMed  Google Scholar 

  10. Dawson, P.M., Habib, N.A., Rees, H.D., Williamson, R.C.N., Wood, C.B.: Influence of sialomucin at the resection margin on local tumour recurrence and survival of patients with colorectal cancer: A multivariate analysis. Br. J. Surg.74:366, 1987

    PubMed  Google Scholar 

  11. Colacchio, T.A., Chabot, J.A., Zimmerman, B.W.: Different mucin staining in colorectal neoplasms: Potential clinical application. Am. J. Surg.147:666, 1984

    Article  PubMed  Google Scholar 

  12. Killingback, M.J.: Indications for local excision of rectal cancer. Br. J. Surg.72:S54, 1985

  13. Biggers, O.R., Beart, R.W., Ilstrup, D.M.: Local excision of rectal cancer. Dis. Colon Rectum29:374, 1986

    PubMed  Google Scholar 

  14. Pilipshen, S.J.: Cancer of the rectum: Local recurrence. In Current Therapy in Colon and Rectal Surgery, V.W. Fazio, editor, Philadelphia, B.C. Decker, Inc., 1989, pages 137–149

    Google Scholar 

  15. Wilson, S.M., Beahrs, O.H.: The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. Ann. Surg.183:556, 1976

    PubMed  Google Scholar 

  16. Quirke, P., Dixon, M.F., Durdey, P., Williams, N.S.: Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: Histopathological study of lateral tumour spread and surgical excision. Lancet2:996, 1986

    Google Scholar 

  17. Heald, R.J., Ryall, R.D.H.: Recurrence and survival after total mesorectal excision for rectal cancer. Lancet1:1479, 1986

    Article  PubMed  Google Scholar 

  18. Pezim, M.E., Nicholls, R.J.: Survival after high or low ligation of inferior mesenteric artery during curative surgery for rectal cancer. Ann. Surg.200:729, 1984

    PubMed  Google Scholar 

  19. Hojo, K., Koyama, Y., Moriya, Y.: Lymphatic spread and its prognostic value in patients with rectal cancer. Am. J. Surg.144:350, 1982

    Article  PubMed  Google Scholar 

  20. Moriya, Y., Hojo K., Sawada, T., Koyama, Y.: Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis. Colon Rectum32:307, 1989

    PubMed  Google Scholar 

  21. Blumberg, N., Heal, J., Chuang, C., Murphy, P., Agarwal M.: Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence. Ann. Surg.207:410, 1988

    PubMed  Google Scholar 

  22. Parrot, N.R., Lennard, T.W.J., Taylor, R.M.R., Proud, G., Shenton, B.K., Johnston, I.D.A.: Effect of perioperative blood transfusion on recurrence of colorectal cancer. Br. J. Surg.73:970, 1986

    PubMed  Google Scholar 

  23. Burrows, L., Tartter, P., Aufses, A.: Increased recurrence rates in perioperatively transfused colorectal malignancy patients. Cancer Detect. Prev.10:361, 1987

    PubMed  Google Scholar 

  24. Hoh, H., Umpleby, H., Cooper, A., Taylor, I.: Recurrence of colorectal cancer and perioperative blood transfusion: Is blood storage time important? Dis. Colon Rectum33:127, 1990

    Article  PubMed  Google Scholar 

  25. Weiden, P.L., Bean, M.A., Schultz, P.: Perioperative blood transfusion does not increase the risk of colorectal cancer recurrence. Cancer60:870, 1987

    PubMed  Google Scholar 

  26. Francis, D.M.A., Judson, R.T.: Blood transfusion and recurrence of cancer of the colon and rectum. Br. J. Surg.74:26, 1987

    PubMed  Google Scholar 

  27. Davis, C.J., Ilstrup, D.M., Pemberton, J.H.: Influence of splenectomy on survival rate of patients with colorectal cancer. Am. J. Surg.155:173, 1988

    PubMed  Google Scholar 

  28. Juhl, G., Larson, G.M., Mullins, R., Bond, S., Polk, H.C. Jr.: Six-year results of annual colonoscopy after resection of colorectal cancer. World J. Surg.14:255, 1990

    Article  PubMed  Google Scholar 

  29. Beart, R.W. Jr., O'Connell, M.J.: Postoperative follow-up of patients with carcinoma of the colon. Mayo Clin. Proc.58:361, 1983

    PubMed  Google Scholar 

  30. Carlsson, U., Stewénius, J., Ekelund, G., Leandoer, L., Nosslin, B.: Is CEA analysis of value in screening for recurrence after surgery for colorectal carcinoma? Dis. Colon Rectum26:369, 1983

    PubMed  Google Scholar 

  31. Attiyeh, F.F., Ellis, H., Killingback, M., Oates, G.D., Schofield, P.F., Staab, H.J., Steele, G. Jr.: Symposium: The management of recurrent colorectal cancer. Int. J. Color. Dis.1:133, 1986

    Article  Google Scholar 

  32. Vasilevsky, C., Gordon, P.H.: Colonoscopy in the follow-up of patients with colorectal carcinoma. Can. J. Surg.31:188, 1988

    PubMed  Google Scholar 

  33. Zheng, G., Eddleston, B., Schofield, P.F., Johnson, R.J., James, R.D.: Computed tomographic scanning in rectal carcinoma. J. R. Soc. Med.77:915, 1984

    PubMed  Google Scholar 

  34. Johnson, R.J., Jenkins, J.P.R., Isherwood, I., James, R.D., Schofield, P.F.: Quantitative magnetic resonance imaging in rectal carcinoma. Br. J. Radiol.60:761, 1987

    PubMed  Google Scholar 

  35. de Lange, E.E., Fechner, R.E., Wanebo, H.J.: Suspected recurrent rectosigmoid carcinoma after abdominoperineal resection: MR imaging and histopathologic findings. Radiology170:323, 1989

    PubMed  Google Scholar 

  36. Beynon, J., Mortensen, N.J.M., Foy, D.M.A., Channer, J.L., Rigby, H., Virjee, J.: The detection and evaluation of locally recurrent rectal cancer with rectal endosonography. Dis. Colon Rectum32:509, 1989

    PubMed  Google Scholar 

  37. Rifkin, M.D., Wechsler, R.J.: A comparison of computed tomography and endorectal ultrasound in staging rectal cancer. Int. J. Color. Dis.1:219, 1986

    Article  Google Scholar 

  38. Wanebo, H.J., Gaker, D.L., Whitehill R., Morgan R.F., Constable, W.L.: Pelvic recurrence of rectal cancer: Options for curative resection. Ann. Surg.205:482, 1987

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Colon and Rectal Surgery and the Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, U.S.A.

    J. Pedro de Azevedo M.D., Roger R. Dozois M.D. & Leonard L. Gunderson M.D.

Authors
  1. J. Pedro de Azevedo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roger R. Dozois M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leonard L. Gunderson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pedro de Azevedo, J., Dozois, R.R. & Gunderson, L.L. Locally recurrent rectal cancer: Surgical strategy. World J. Surg. 16, 490–494 (1992). https://doi.org/10.1007/BF02104453

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02104453

Keywords

Search

Navigation