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Pelvic sidewall involvement in recurrent rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

The lateral pelvic sidewall is an area not routinely dissected during standard operative procedures in surgery for rectal cancer in Western countries. This study analyzed data to evaluate the pattern of recurrence in rectal cancer with special emphasis on lateral tumor extension in a recently treated patient population.

Patients and methods

In a multicenter retrospective study 123 patients were evaluated by our own CT-based three-dimensional datafile system and an extensive questionnaire. Patients had histological confirmation, clear bone destruction, a positive PET scan, and at least three minor criteria: progressive soft tissue mass, invasion of adjacent organs on follow-up CT or MRI, rising tumor markers, and typical appearance in cross-sectional imaging. Clinical or serological signs of inflammation were exclusion criteria. Initially 54% of the evaluated patients were N0, and the others were distributed evenly between N1 and N2; initial T stage was T1 in 2%, T2 in 24%, T3 in 60%, and T4 in 13%.

Results

Recurrent tumors were situated mainly in the posterior part of the bony pelvis. The pelvic side wall was a rare site of recurrence and involved in fewer than 5%. When abdominoperineal resection was compared to low anterior resection as primary operation, there was a significant difference in extension of recurrent tumors in the inferior parts of the pelvis; no significant differences were found in superior or lateral parts of the pelvis.

Conclusion

Because most tumor recurrences arise in the central pelvis, extending surgery to include dissecting the iliac vessels would probably offer only a moderate benefit, which must be balanced against potential side effects.

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Acknowledgements

Contributers to this study were the Clinics for Radiation Oncology and Radiotherapy of: Klinikum Bamberg (H.-J. Thiel), University Hospital Charite, Campus Virchow Klinikum, Berlin (P. Wust), University Hospital Würzburg (M. Flentje), University Hospital Carl Gustav Carus TU, Dresden (T. Herrmann), University Hospital Aachen (M. Eble), General Hospital St. Georg, Hamburg (D. Carstens), University Hospital Marburg (R. Engenhardt-Cabillic), and General Hospital Neukölln, Berlin (U. Höller).

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Authors and Affiliations

  1. Clinic for Radiation Oncology and Radiotherapy, Hindenburgdamm 30, 12200, Berlin, Germany

    Stefan Höcht, Riad Hammad, Alessandra Siegmann, Thomas Wiegel & Wolfgang Hinkelbein

  2. Surgical Clinic I, General, Vascular, and Visceral Surgery, Hindenburgdamm 30, 12200, Berlin, Germany

    Benno Mann, Christoph-Thomas Germer & Heinz-Johannes Buhr

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  1. Stefan Höcht
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  8. Wolfgang Hinkelbein
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Correspondence to Stefan Höcht.

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Höcht, S., Mann, B., Germer, CT. et al. Pelvic sidewall involvement in recurrent rectal cancer. Int J Colorectal Dis 19, 108–113 (2004). https://doi.org/10.1007/s00384-003-0544-6

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