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Annals of Surgical Oncology

, Volume 18, Issue 4, pp 1015–1022 | Cite as

Clinicopathological Assessment of Locally Recurrent Rectal Cancer and Relation to Local Re-Recurrence

  • Mamoru Uemura
  • Masataka IkedaEmail author
  • Hirofumi Yamamoto
  • Kotaro Kitani
  • Masayoshi Tokuoka
  • Ken Matsuda
  • Yuki Hata
  • Tsunekazu Mizushima
  • Ichiro Takemasa
  • Mitsugu Sekimoto
  • Ko Hosokawa
  • Nariaki Matsuura
  • Yuichiro Doki
  • Masaki Mori
Colorectal Cancer

Abstract

Background

Local re-recurrence after R0 resection of local recurrence of rectal cancer (LRRC) is not rare. The purpose of this study was to examine the pathological features of LRRC and determine the prognostic factors.

Methods

Twenty-one patients underwent R0 resection of LRRC without preoperative therapy from 2000 to 2008. Tumor progression patterns were classified into three types: A, expanding type; B, infiltrating type; and C, intermediate type. Distant isolated cancer cells (DICCs) were defined as cancer cells present in isolation and at a distance (>1 mm) from the tumor edge.

Results

Venous invasion was identified in all but one patient (95%). DICCs were observed in 11 of 21 cases. Type A patients had a significantly lower local re-recurrence rate (0/5) compared with type B and/or C patients (11/16, P = 0.012) and a significantly lower incidence of distant metastasis compared with type B and C patients (0/5 vs. 13/16, respectively; P = 0.0028). Multivariate regression analysis identified venous invasion of the primary lesion (P = 0.027) and tumor progression patterns (P = 0.039) as independent predictors of local re-recurrence.

Conclusions

The main features of LRRC were infiltrating growth, venous invasion, and DICCs. Tumor progression patterns correlated with local re-recurrence and distant metastasis. Preoperative adjuvant therapy to terminate peri-tumor cancer cells may be required for better tumor control.

Keywords

Rectal Cancer Venous Invasion Circumferential Resection Margin Tumor Regression Grade Tumor Edge 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

10434_2010_1435_MOESM1_ESM.pdf (28 kb)
Supplementary material 1 (PDF 28 kb)
10434_2010_1435_MOESM2_ESM.pdf (6 kb)
Supplementary Fig. 1: Local re-recurrence-free survival according to type of tumor. Kaplan–Meier local re-recurrence-free survival curves according to classification of tumor infiltration. Local re-recurrence-free survival was significantly lower in the type B and/or type C group compared with type A (P = 0.0375, log-rank test) (PDF 6.36 kb)

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Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Mamoru Uemura
    • 1
  • Masataka Ikeda
    • 1
    Email author
  • Hirofumi Yamamoto
    • 1
  • Kotaro Kitani
    • 1
  • Masayoshi Tokuoka
    • 1
  • Ken Matsuda
    • 2
  • Yuki Hata
    • 2
  • Tsunekazu Mizushima
    • 1
  • Ichiro Takemasa
    • 1
  • Mitsugu Sekimoto
    • 1
  • Ko Hosokawa
    • 2
  • Nariaki Matsuura
    • 3
  • Yuichiro Doki
    • 1
  • Masaki Mori
    • 1
  1. 1.Department of Surgery; Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuita CityJapan
  2. 2.Department of Plastic Surgery, Graduate School of MedicineOsaka UniversitySuita CityJapan
  3. 3.Department of Pathology, School of Allied Health Science, Faculty of MedicineOsaka UniversitySuita CityJapan

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