Abstract
Background: We aimed to determine the outcome of resections for local recurrence of colorectal carcinoma in the presence of distant (M1) disease.
Methods: Patients who underwent resection of local recurrence in the presence of potentially resectable M1 disease were identified from the colorectal database. Outcome was determined by chart review.
Results: Forty-two patients (23 men) of mean age 60 years (range, 34–88 years) underwent complete gross resection of their local recurrence in the presence of M1 disease. Thirteen of the 42 underwent synchronous M1 resections to render them free of gross disease (R0). Nine of the 29 patients who left with residual disease (R1) subsequently underwent staged M1 resection, so that 22 of 42 were rendered R0 by surgery. The median survival of all patients was 14.5 months (interquartile range, 6–30 months), and that of patients rendered R0 was 23 months (interquartile range, 10–37 months), in comparison with 7 months (interquartile range, 3–25 months) for those of R1 status (P = .006; log-rank method). Ability to achieve R0 status by synchronous or staged resection was the only factor predictive of survival.
Conclusions: The presence of M1 disease per se should not preclude resection of local recurrence, although case selection is problematic.
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REFERENCES
Cohen AM, Minsky BD, Schilsky RL. Cancer of the colon. In: Devita VT, Hellman S, Rosenberg SA, eds. Cancer—Principles and Practice of Oncology. 5th ed. Philadelphia: Lippincott, 1997.
Pilipshen SJ, Heilwell M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984; 53: 1354–62.
Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Cancer 1974; 34: 1278–92.
Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum H, Hintz BL. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981; 48: 1492–5.
Rich T, Gunderson LL, Lew R, Galbidini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983; 52: 1317–29.
Welch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg 1978; 135: 505–11.
Salo JC, Paty PB, Guillem J, Minsky BD, Harrison LB, Cohen AM. Surgical salvage of recurrent rectal carcinoma after curative resection: a ten year experience. Ann Surg Oncol 1999; 6: 171–7.
Gagliardi G, Hawley PR, Hershman MJ, Arnott SJ. Prognostic factors in surgery for local recurrences of rectal cancer. Br J Surg 1995; 82: 1401–5.
Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994; 220: 586–97.
Tschmelitsch J, Kronberger P, Glaser K, Klingler A, Bodner E. Survival after surgical treatment of recurrent carcinoma of the rectum. J Am Coll Surg 1994; 179: 54–8.
Maetani S, Onodera H, Nishikawa T, et al. Significance of local recurrence of rectal cancer as a local or disseminated disease. Br J Surg 1998; 85: 521–5.
Huguier M, Houry S. Treatment of local recurrence of rectal cancer. Am J Surg 1998; 175: 288–92.
Eckhauser FE, Knol JA. Surgery for primary and metastatic colorectal cancer. Gastroenterol Clin North Am 1997; 26: 104–28.
Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer. Br J Surg 1996; 83: 293–304.
Gayowski TJ, Iwatsuki S, Madariaga JR, et al. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 1994; 116: 703–10; discussion 710–1.
Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of Hepatic Metastases. Surgery 1988; 103: 278–88.
Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990; 77: 1241–6.
Goya T, Miyazawa N, Kondo H, et al. Surgical resection of pulmonary metastases from colorectal cancer: 10-year follow-up. Cancer 1989; 64: 1418–21.
Sauter ER, Bolton JS, Willis GW, et al. Improved survival after pulmonary resection of metastatic colorectal carcinoma. J Surg Oncol 1990; 43: 135–8.
Suzuki K, Dozois RR, Devine RM, et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum 1996; 39: 730–6.
Flanagan DL, Dehdashti F, Ogunbiyi OA, Kodner IJ, Siegel BA. Utility of FDG-PET for investigating unexplained plasma CEA elevation in patients with colorectal cancer. Ann Surg 1998; 27: 319–23.
Guillem JG, Puig-La Calle J Jr, Akhurst T, et al. Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography. Dis Colon Rectum 2000; 43: 18–24.
Dicle O, Obuz F, Cakmakci H. Differentiation of recurrent rectal cancer and scarring with dynamic MR imaging. Br J Radiol 1999; 72: 1155–9.
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Hartley, J.E., Lopez, R.A., Paty, P.B. et al. Resection of Locally Recurrent Colorectal Cancer in the Presence of Distant Metastases: Can It Be Justified?. Ann Surg Oncol 10, 227–233 (2003). https://doi.org/10.1245/ASO.2003.05.039
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DOI: https://doi.org/10.1245/ASO.2003.05.039