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Aggressive surgical management of locally advanced primary and recurrent rectal cancer

Current status and future directions

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

Patients with locally advanced primary and recurrent rectal cancer without gross evidence of extrapelvic cancer represent a complex challenge to the surgeon. In selected patients, radical incontinuity resection or resection combined with radical radiation therapy offers a high likelihood of local tumor control and, to a lesser degree, the possibility of cure. This article defines current approaches to the aggressive management of such patients and investigative strategies for the future.

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References

  1. Dobrowsky W, Schmid AP. Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma. Dis Colon Rectum 1985;28:917–9.

    PubMed  Google Scholar 

  2. Pacini P, Cionini L, Pirtoli L, Ciatto S, Tucci E, Sebaste L. Symptomatic recurrences of carcinoma of the rectum and sigmoid: the influence of radiotherapy on the quality of life. Dis Colon Rectum 1986;29:865–8.

    PubMed  Google Scholar 

  3. Stearns MW Jr. Diagnosis and management of recurrent pelvic malignancy following combined abdominoperineal resection. Dis Colon Rectum 1980;23:359–61.

    PubMed  Google Scholar 

  4. Benotti PN, Bothe A, Eyere RC, Cady B, McDermott MV, Steele G. Management of recurrent pelvic tumors. Arch Surg 1987;122:457–60.

    PubMed  Google Scholar 

  5. 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 Rectum 1989;32:307–315.

    PubMed  Google Scholar 

  6. Sannella NA. Abdominoperineal resection following anterior resection. Cancer 1976;38:378–81.

    PubMed  Google Scholar 

  7. Vassilopoulos PP, Yoon JM, Ledesma EJ, Mittelman A. Treatment of recurrence of adenocarcinoma of the colon and rectum at the anastomotic site. Surg Gynecol Obstet 1981;152:777–80.

    PubMed  Google Scholar 

  8. Pihl E, Hughes ES, McDermott FT, Price AB. Recurrence of carcinoma of the colon and rectum at the anastomotic suture line. Surg Gynecol Obstet 1981;153:495–6.

    PubMed  Google Scholar 

  9. Polk HC Jr, Spratt JS Jr. The results of treatment of perineal recurrence of cancer of the rectum. Cancer 1979;43:952–5.

    PubMed  Google Scholar 

  10. Wilking N, Herrera L, Petrelli NJ, Mittelman A. Pelvic and perineal recurrences after abdominoperineal resection for adenocarcinoma of the rectum. Am J Surg 1985;150:150–563.

    Google Scholar 

  11. Kraybill WG, Lopez MJ, Bricker EM. Total pelvic exenteration as a therapeutic option in advanced malignant disease of the pelvis. Surg Gynecol Obstet 1988;166:259–63.

    PubMed  Google Scholar 

  12. Lopez MJ, Kraybill WG, Downey RS, Johnston WD, Bricker EM. Exenterative surgery for locally advanced rectosigmoid cancers. Is it worthwhile? Surgery 1987;102:644–51.

    PubMed  Google Scholar 

  13. Boey J, Wong J, Ong GB. Pelvic exenteration for locally advanced colorectal carcinoma. Ann Surg 1982;195:513–8.

    PubMed  Google Scholar 

  14. Ledesma EJ, Bruno S, Mittelman A. Total pelvic exenteration in colorectal disease. Ann Surg 1981;194:701–3.

    PubMed  Google Scholar 

  15. Wanebo HJ, Marcove RC. Abdominal sacral resection of locally recurrent rectal cancer. Ann Surg 1981;194:458–71.

    PubMed  Google Scholar 

  16. Sugarbaker PH. Partial sacrectomy foren bloc excision of rectal cancer with posterior fixation. Dis Colon Rectum 1982;25:708–11.

    PubMed  Google Scholar 

  17. Pearlman NW, Stiegmann GV, Donohue RE. Extended resection of fixed rectal cancer. Cancer 1989;63:2438–41.

    PubMed  Google Scholar 

  18. Wanebo H. Resection of pelvic recurrence of rectal cancer. Contemp Surg 1982;21:21–33.

    Google Scholar 

  19. Wanebo HJ, Gaker DL, Whitehill R, Morgan RF, Constable WC. Pelvic recurrence of rectal cancer. Ann Surg 1987;205:482–95.

    PubMed  Google Scholar 

  20. Wanebo HJ, Whitehill R, Gaker D, Wang GJ, Morgan R, Constable W. Composite pelvic resection. Arch Surg 1987;122:1401–6.

    PubMed  Google Scholar 

  21. Pearlman NW, Donohue RE, Stiegmann GV, Ahnen DJ, Sedlacek SM, Braun TJ. Pelvic and sacropelvic exenteration for locally advanced or recurrent anorectal cancer. Arch Surg 1987;122:537–41.

    PubMed  Google Scholar 

  22. Mendenhall WM, Bland KI, Pfaff WW, et al. Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery. Ann Surg 1986;205:41–4.

    Google Scholar 

  23. Rao AR, Kagan AR, Chan PYM, et al. Effectiveness of local radiotherapy in colorectal carcinoma. Cancer 1978;42:1082–6.

    PubMed  Google Scholar 

  24. Cummings BJ, Rider WA, Harwood AR, Keane TJ, Thomas GM. Radical external beam radiation therapy for adenocarcinoma of the rectum. Dis Colon Rectum 1983;26:30–6.

    PubMed  Google Scholar 

  25. Ghossein NA, Samala EC, Alpert S, et al. Elective postoperative radiotherapy after incomplete resection of colorectal cancer. Dis Colon Rectum 1981;24:252–6.

    PubMed  Google Scholar 

  26. Rominger CJ, Gelber RD, Gunderson LL, et al. Radiation therapy alone or in combination with chemotherapy in the treatment of residual or inoperable carcinoma of the rectum and rectosigmoid or pelvic recurrence following colorectal surgery. Radiation Therapy Oncology Group study (76–16). Am J Clin Oncol 1985;8:118–27.

    PubMed  Google Scholar 

  27. Taylor RE, Kerr GR, Arnott SJ. External beam radiotherapy for rectal adenocarcinoma. Br J Surg 1987;74:455–9.

    PubMed  Google Scholar 

  28. Allee P, Gunderson LL, Munzenrider JE. Postoperative radiation therapy for residual colorectal carcinoma. Int J Radiat Oncol Biol Phys 1981;7:1208.

    Google Scholar 

  29. Schild SE, Martenson JA, Gunderson LL, et al. Long-term survival and patterns of failure after postoperative radiation therapy for subtotally resected rectal adenocarcinoma. Int J Radiat Oncol Biol Phys 1989;16:459–63.

    PubMed  Google Scholar 

  30. Danjoux CE, Gelber RD, Catton GE, et al. Combination chemoradiotherapy for residual, recurrent, or inoperable carcinoma of the rectum: ECOG Study (EST 3276). Int J Radiat Oncol Biol Phys 1985;11:765–71.

    PubMed  Google Scholar 

  31. Dosoretz DE, Gunderson LL, Hedberg S, et al. Preoperative irradiation for unresectable rectal and rectosigmoid carcinoma. Cancer 1983;523:814–8.

    Google Scholar 

  32. Emami B, Willet C, Pilepich M, et al. Effect of preoperative irradiation on resectability of colorectal carcinomas. Int J Radiat Oncol Biol Phys 1982;8:1295–9.

    PubMed  Google Scholar 

  33. Fortier GA, Krochak RJ, Jung AK, Constable WC. Dose response to preoperative irradiation in rectal cancer: implications for local control and complications associated with sphincter sparing surgery and abdominoperineal resection. Int J Radiat Oncol Biol Phys 1986;12:1559–63.

    PubMed  Google Scholar 

  34. Cohen AM. Intraoperative radiation therapy for colorectal cancer. Probl Gen Surg 1987;4:76–82.

    Google Scholar 

  35. Hilaris BS, Nori D, Anderson LL. Atlas of Brachytherapy. New York: Macmillan, 1988.

    Google Scholar 

  36. Tepper JE, Cohen AM, Wood WC, et al. Intraoperative electron beam radiotherapy in the treatment of unresectable rectal carcinoma. Arch Surg 1986;121:421–3.

    PubMed  Google Scholar 

  37. Gunderson LL, Martin JK, Beart RW. Intraoperative and external beam irradiation for locally advanced colorectal cancer. Ann Surg 1988;207:52–60.

    PubMed  Google Scholar 

  38. Beart RW Jr, Martin JK Jr, Gunderson LL. Management of recurrent rectal cancer. Mayo Clin Proc 1986;61:448–50.

    PubMed  Google Scholar 

  39. Minsky BD, Shank B, Nori D. Subtotal resection and intraoperative brachytherapy in recurrent rectosigmoid and rectal cancer. Endocurie Hypertherm Oncol (in press).

  40. Leroy M, Teillac P, Rain JD, Saccavini JC, Le Duc A, Najean Y. Radioimmunodetection of lymph node invasion in prostatic cancer. Cancer 1989;64:1–5.

    PubMed  Google Scholar 

  41. Michelassi F, Erroi F, Roncella M, Block GE.Ras oncogene and the acquisition of metastasizing properties by rectal adenocarcinoma. Dis Colon Rectum 1989;32:665–8.

    PubMed  Google Scholar 

  42. Hautmann RE, Egghart G, Frohnenberg D, Miller K. The ileal neo-bladder. J Urol 1988;139:39–42.

    PubMed  Google Scholar 

  43. Meigooni AS, Nath R. Dosimetry of Pd-103 model 200 sources for interstitial brachytherapy. Endocurie Hypertherm Oncol 1989;5:64.

    Google Scholar 

  44. Kaufman N, Nori D, Shank B, et al. Remote afterloading intraluminal brachytherapy in the treatment of rectal, rectosigmoid, and anal cancer: a feasibility study. Int J Radiat Oncol Biol Phys 1989;17:663–8.

    PubMed  Google Scholar 

  45. Cox JD, Guse C, Asbell S, et al. Tolerance of pelvic normal tissues to hyperfractionated radiation therapy: results of protocol 83-08 of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1988;15:1331–6.

    PubMed  Google Scholar 

  46. Duncan W, Arnott SJ, Jack WJL, et al. Results of two randomized trials of neutron therapy in rectal adenocarcinoma. Radiother Oncol 1987;8:191–8.

    PubMed  Google Scholar 

  47. Battermann JJ. Results of d + T fast neutron irradiation on advanced tumors of the bladder and rectum. Int J Radiat Oncol Biol Phys 1982;8:2159–64.

    PubMed  Google Scholar 

  48. Meyerson RJ, Emani B, Perez CA, Gibbs F, Lee C, Pajak T. Phase I/II study, combination of radiotherapy and hyperthermia in patients with deep-seated malignant tumors: report of a pilot study. Int J Radiat Oncol Biol Phys 1989;17:204.

    Google Scholar 

  49. Shank B, LoSasso T, Brewster L, et al. Three-dimensional treatment planning for post-operative treatment of rectal carcinoma. Int J Radiat Oncol Biol Phys (in press).

  50. Devereux DF, Eisenstat T, Zinkin L. The safe and effective use of postoperative radiation therapy in modified Astler-Coller Stage C3 rectal cancer. Cancer 1989;63:2393–6.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

    Alfred M. Cohen M.D.

  2. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Bruce D. Minsky M.D.

Authors
  1. Alfred M. Cohen M.D.
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  2. Bruce D. Minsky M.D.
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Cohen, A.M., Minsky, B.D. Aggressive surgical management of locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 33, 432–438 (1990). https://doi.org/10.1007/BF02156274

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