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Surgery for local recurrence of rectal carcinoma

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was designed to evaluate results, especially mortality and morbidity, of surgical resection with curative intent for patients with a local recurrence of rectal cancer, in combination with radiotherapy. METHODS: Consecutive medical records of 163 patients with local recurrence of rectal carcinoma after previous “curative” therapy for primary rectal cancer were reviewed. Although 35 patients had an exploratory laparotomy, only 27 had local recurrence amendable to resection (6 irresectable locoregional recurrences and 2 distant metastases found at laparotomy). Twenty-one patients received radiotherapy. There was no perioperative mortality. Median follow-up time was 42 (range, 22–92) months. RESULTS: Local rerecurrence occurred in 16 (59 percent) patients. Ten patients are alive, of whom nine have good local control. Estimated five-year survival (Kaplan-Meier) is 20 percent. Survival was significantly better in patients without a second recurrence, but radicality of the resection was not influential. Good local control could be obtained in 12 (44 percent) patients, and 1 patient is living with symptoms. CONCLUSIONS: In selected patients with local recurrence of rectal carcinoma, reoperation with irradiation may result in good palliation and possibly cure.

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References

  1. Gunderson LL, 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. Cancer 1974;34:1278–92.

    PubMed  CAS  Google Scholar 

  2. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following ’curative’ surgery for large bowel cancer: I. The overall picture. Br J Surg 1984;71:12–6.

    PubMed  CAS  Google Scholar 

  3. Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.

    PubMed  CAS  Google Scholar 

  4. McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–7.

    PubMed  CAS  Google Scholar 

  5. Terranova O, Celi D, Martella B, Battocchio F. Local recurrence of rectal cancer: anterior resectionversus abdominoperineal resection. Int Surg 1988;73:111–3.

    Google Scholar 

  6. Michelassi F, Vannucci L, Ayala JJ, Chappel R, Goldberg R, Block GE. Local recurrence after curative resection of colorectal adenocarcinoma. Surgery 1990;108:787–93.

    PubMed  CAS  Google Scholar 

  7. Amato A, Pescatori M, Butti A. Local recurrence following abdominoperineal excision and anterior resection for rectal carcinoma. Dis Colon Rectum 1991;34:317–22.

    PubMed  CAS  Google Scholar 

  8. Mohiuddin M, Marks G. Patterns of recurrence following high-dose preoperative radiation and sphincterpreserving surgery for cancer of the rectum. Dis Colon Rectum 1993;36:117–26.

    Article  PubMed  CAS  Google Scholar 

  9. Sanella NA. Abdominoperineal resection following anterior resection. Cancer 1976;38:378–81.

    PubMed  Google Scholar 

  10. Segall MM, Goldberg SM, Nivatvongs S,et al. Abdominoperineal resection for recurrent cancer following anterior resection. Dis Colon Rectum 1981;24:80–4.

    PubMed  CAS  Google Scholar 

  11. 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  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  13. Miller LB, Steele G, Cady B, Wolfort FG, Bothe A Jr. Resection of tumors in irradiated fields with subsequent immediate reconstruction. Arch Surg 1987;122:461–6.

    PubMed  CAS  Google Scholar 

  14. Pearlman NW, Donohue RE, Stiegman 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  CAS  Google Scholar 

  15. Steele G Jr, Ravikumar TS, Benotti PN. New surgical treatments for recurrent colorectal cancer. Cancer 1990;65:723–30.

    PubMed  Google Scholar 

  16. 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 

  17. Temple WJ, Ketcham AS. Surgical palliation for recurrent rectal cancers ulcerating in the perineum. Cancer 1990;65:1111–4.

    PubMed  CAS  Google Scholar 

  18. Van Geel AN, Wiggers Th. The pedicled omentoplasty: technical aspects in reconstructive and protective surgery. Eur J Surg 1991;43:150–3.

    Google Scholar 

  19. Welch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg 1978;135:505–11.

    Article  PubMed  CAS  Google Scholar 

  20. Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg 1986;73:342–4.

    CAS  PubMed  Google Scholar 

  21. Mentges B, Mentges W, Grussner R, Bruckner R. Art und prognose des lokoregionaren rezidivs beim rektumkarzinom. Dtsch Med Wschr 1988;113:806–10.

    PubMed  CAS  Google Scholar 

  22. Duncan W. Adjuvant radiotherapy in rectal cancer: the MRC trials. Br J Surg 1985;72(Suppl):59–66.

    PubMed  Google Scholar 

  23. Eigler FW. Wert und komplikationen der pra- und postoperativen Strahlentherapie aus der sicht des Chirurgen. Langenbecks Arch Chir Suppl (Kongressbd) 1989:717–21.

  24. Påhlman L, Glimelius B. Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma: report from a randomized multicenter trial. Ann Surg 1990;211:187–95.

    Article  PubMed  Google Scholar 

  25. Stockholm Rectal Cancer Study Group. Preoperative short-term radiation therapy in operable rectal carcinoma. Cancer 1990;66:49–55.

    Google Scholar 

  26. Fujimoto S, Takahashi M, Endoh F,et al. A clinical pilot study combining surgery with intraoperative pelvic hyperthermochemotherapy to prevent the local recurrence of rectal cancer. Ann Surg 1991;213:43–7.

    PubMed  CAS  Google Scholar 

  27. Willett CG, Shellito PC, Tepper JE, Eliseo R, Convery K, Wood WC. Intraoperative electron beam radiation therapy for primary locally advanced rectal and rectosigmoid carcinoma. J Clin Oncol 1991;9:843–9.

    PubMed  CAS  Google Scholar 

  28. Engenhart R, Kimmig B, Marin-Grez M, Hover KH, Flentje M, zum Winkel K. Combined neutron-photon-therapy of locally recurrent rectosigmoidal tumors. Strahlenther Onkol 1989;165:327–9.

    PubMed  CAS  Google Scholar 

  29. Lybeert ML, Martijn H, de Neve W, Crommelin MA, Ribot JG. Radiotherapy for locoregional relapses of rectal carcinoma after initial radical surgery: definitite but limited influence on relapse-free survival and survival. Int J Radiat Oncol Biol Phys 1992;24:241–6.

    PubMed  CAS  Google Scholar 

  30. Bacon HE, Berkley JL. The rationale of re-resection for recurrent cancer of the colon and the rectum. Dis Colon Rectum 1959;2:549–54.

    PubMed  CAS  Google Scholar 

  31. Schildberg FW. Probleme des lokalrezidivs nach colorectalem carcinom. Langenbecks Arch Chir (Kongressbd) 1987;372:505–11.

    Article  CAS  Google Scholar 

  32. Liavåg I. Detection and treatment of local recurrence. Scand J Gastroenterol 1988;149(Suppl):163–5.

    Google Scholar 

  33. Benotti PN, Bothe A Jr, Eyre RC, Cady B, McDermott WV, Steele G. Management of recurrent pelvic tumors. Arch Surg 1987;122:457–60.

    PubMed  CAS  Google Scholar 

  34. Estes NC, Thomas JH, Jewell WR, Beggs D, Hardin CA. Pelvic exenteration: a treatment for failed rectal cancer surgery. Am Surg 1993;59:420–2.

    PubMed  CAS  Google Scholar 

  35. Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994;220:586–97.

    PubMed  CAS  Google Scholar 

  36. Sugarbaker PH. Partial sacrectomy for en-block excision of rectal cancer with posterior fixation. Dis Colon Rectum 1982;25:708–11.

    PubMed  CAS  Google Scholar 

  37. Takagi H, Morimoto T, Kato T. Diagnosis and operation for locally recurrent rectal cancer. J Surg Oncol 1985;28:290–6.

    PubMed  CAS  Google Scholar 

  38. Maetani S, Nishikawa T, Iijima Y,et al. Extensive enblock resection of regionally recurrent carcinoma of the rectum. Cancer 1992;69:2876–83.

    PubMed  CAS  Google Scholar 

  39. Wanebo HJ, Llaneras M, Martin T, Kaiser D. Prospective monitoring trial for carcinoma of colon and rectum after surgical resection. Surg Gynecol Obstet 1989;169:479–87.

    PubMed  CAS  Google Scholar 

  40. O'Connell MJ, Childs DS, Moertel CG, Holbrook MA, Schutt AJ, Rubin RE Jr. A prospective controlled evaluation of combined pelvic radiotherapy and methanol extraction residue of BCG (MER) for locally unresectable or recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys 1982;8:1115–9.

    PubMed  Google Scholar 

  41. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:465–72.

    Google Scholar 

  42. Ketcham AS. The management of recurrent rectal carcinoma. Can J Surg 1985;28:422–4.

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  44. Jones DJ, Zaloudik J, James RD, Haboubi N, Moore M, Schofield PF. Predicting local recurrence of carcinoma of the rectum after preoperative radiotherapy and surgery. Br J Surg 1986;76:1172–5.

    Google Scholar 

  45. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1982;69:613–6.

    PubMed  CAS  Google Scholar 

  46. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479–82.

    Article  PubMed  CAS  Google Scholar 

  47. Cawthorn SJ, Parums DV, Gibbs NM,et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 1990;335:1055–9.

    Article  PubMed  CAS  Google Scholar 

  48. Müller H, Aiger KR. Isolated pelvic perfusion for nonresectable pelvic tumors—a pilot study. Reg Cancer Treat 1989;2:92.

    Google Scholar 

  49. Turk PS, Belliveau JF, Darnowski JW, Weinberg MC, Leenen L, Wanebo HJ. Isolated pelvic perfusion for unresectable cancer using a balloon occlusion technique. Arch Surg 1993;128:533–9.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Dr. Daniël den Hoed Cancer Center, Groene Hilledijk 301, 3075, EA Rotterdam, The Netherlands

    Theo Wiggers M.D., Ph.D. & Mark R. de Vries M.D.

  2. Department of Radiotherapy, Dr. Daniël den Hoed Cancer Center, Rotterdam, The Netherlands

    Bernadette Veeze-Kuypers M.D.

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  1. Theo Wiggers M.D., Ph.D.
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  2. Mark R. de Vries M.D.
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  3. Bernadette Veeze-Kuypers M.D.
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Read at the meeting of the European Society for Surgical Oncology, Heidelberg, Germany, June 11, 1994.

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Wiggers, T., de Vries, M.R. & Veeze-Kuypers, B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum 39, 323–328 (1996). https://doi.org/10.1007/BF02049476

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