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Impact of computed tomographyvs. intrarectal ultrasound on the diagnosis, resectability, and prognosis of locally recurrent rectal cancer

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

The use of modern techniques of imaging in the postoperative follow-up is reported to allow an earlier diagnosis of local recurrence in patients operated on with anterior resection for rectal cancer and, consequently, to allow a higher percentage of local recurrence resection to be performed. Although intrarectal ultrasound (IU) has proved highly reliable in preoperative staging, its value in relapse detection has been investigated only in retrospective studies and rarely compared with that of computed tomography (CT). The present prospective study aims at evaluating the role of IUvs. CT in the diagnosis of local recurrence and at verifying whether an earlier diagnosis and a higher resectability rate of recurrence result in an acceptable long-term survival. Thirty-seven patients who had undergone low and ultralow anterior resection for rectal cancer (anastomosis within 10 cm of the anal verge) were investigated prospectively. All the patients have been followed up by IU and CT at predetermined intervals. Six local recurrences were detected. CT correctly identified all the local recurrences (sensitivity = 100 percent, specificity = 93 percent, and accuracy = 94.5 percent); IU correctly identified only four of six local recurrences (sensitivity = 66.6 percent, specificity = 93 percent, and accuracy = 89 percent). Four patients with local recurrence underwent surgical treatment (resectability rate = 66.6 percent). Abdominoperineal resection in three patients and Hartmann's procedure in one patient were performed. In the other two patients, extensive metastatic liver involvements contraindicated surgery. All the resected patients were alive after one year; two of them are disease free, and the other two experienced recurrent disease. In conclusion, CT seems to have a higher sensitivity and accuracy in relapse detection. The increase in the local recurrence resectability rate does not result in a significant improvement in longterm survival. However, the good quality of life justifies the high cost of an intensive follow-up and a more aggressive surgical approach.

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References

  1. Beynon J, Foy DM, Roe AM, Temple LN, Mortensen NJ. Endoluminal ultrasound assessment of local invasion in rectal cancer. Br J Surg 1986;73:474–7.

    Google Scholar 

  2. Rifkin MD, Marks GJ. Transrectal US as an adjunct in the diagnosis of rectal and extrarectal tumors. Radiology 1985;157:499–502.

    Google Scholar 

  3. Kramann B, Hildebrandt U. Computed tomography versus endosonography in the staging of rectal carcinoma: a comparative study. Int J Colorectal Dis 1986;1:216–8.

    Google Scholar 

  4. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–6.

    Google Scholar 

  5. Romano G, De Rosa P, Vallone G, Rotondo A, Grassi R, Santangelo ML. Intrarectal ultrasound and computed tomography in the pre and post operative assessment of patients with rectal cancer. Br J Surg 1985;72(suppl):S117–9.

    Google Scholar 

  6. Hildebrandt U, Klein T, Feifel G, Schwarz H-P, Koch B, Schmitt RM. Endosonography of pararectal lymph nodes:in vitro andin vivo evaluation. Dis Colon Rectum 1990;33:863–8.

    Google Scholar 

  7. Mascagni D, Corbellini P, Urcioli P, Lapoano R, Marchegiani C, Di Matteo G. L'ecografia endoluminale nel controllo del paziente operato per cancro del retto. G Chir 1988;4:181–99.

    Google Scholar 

  8. Zainea GG, Lee F, McLeary RD, Siders DB, Thieme ET. Transrectal ultrasonography in the evaluation of rectal and extrarectal disease. Surg Gynecol Obstet 1989;169:153–6.

    Google Scholar 

  9. Kodner IJ, Shemesh EI, Fry RD,et al. Preoperative irradiation for rectal cancer. Improved local control and long term survival. Ann Surg 1989;209:194–9.

    Google Scholar 

  10. Romano G, Giamundo P, D'Alessandro V, Santangelo ML. Le nuove tecnologie nella diagnosi e trattamento delle recidive locali da cancro del retto. Chirurgia 1989;6:301–4.

    Google Scholar 

  11. Beynon J, Mortensen NJ, Foy DM, Channer JL, Rigby H, Virjee J. The detection and evaluation of locally recurrent rectal cancer with rectal endosonography. Dis Colon Rectum 1989;32:509–17.

    Google Scholar 

  12. Heintz A, Buess G, Frank K, Kreitner K, Junginger T. Endoluminal sonography in follow up of rectal carcinoma. Surg Endosc 1989;3:199–202.

    Google Scholar 

  13. Waldron RP, Donovan IA. Clinical follow up and treatment of locally recurrent colorectal cancer. Dis Colon Rectum 1987;30:428–30.

    Google Scholar 

  14. Attiyeh FF, Ellis H, Killingback M,et al. The management of colorectal cancer. Int J Colorectal Dis 1986;1:133–51.

    Google Scholar 

  15. Lee JK, Stanley RJ, Sagel SS. CT appearance of the pelvis after abdominoperineal resection for rectal carcinoma. Radiology 1981;141:737–41.

    Google Scholar 

  16. Dukes CE, Bussey HJ. The spread of rectal cancer and its effect on prognosis. Br J Cancer 1958;12: 309–20.

    Google Scholar 

  17. Lockhart-Mummery HE, Ritchie JK, Hawley PR. The results of surgical treatment for carcinoma of the rectum at St. Mark's Hospital 1948–1972. Br J Surg 1976;63:673–7.

    Google Scholar 

  18. Whittaker M, Goligher JC. The prognosis after treatment for carcinoma of the rectum. Br J Surg 1976; 63:384–8.

    Google Scholar 

  19. Williams NS, Durdey P, Quirke P,et al. Pre operative staging of rectal neoplasm and its impact on clinical management. Br J Surg 1985;72:868–74.

    Google Scholar 

  20. Galloway DJ, Cohen AM, Shank B, Friedman MA. Adjuvant multimodality treatment of rectal cancer. Br J Surg 1989;76:440–7.

    Google Scholar 

  21. Gastrointestinal Study Group. Nauta R, Stablein DM, Holyoke ED. Survival of patients with stage B2 colon carcinoma. Arch Surg 1989;124:180–2.

    Google Scholar 

  22. Nicholls RJ, Mason AJ, Morson BC, Dixon AK, Fry IK. The clinical staging of rectal cancer. Br J Surg 1982;69:404–9.

    Google Scholar 

  23. York Mason AJ. Rectal cancer: the spectrum of selective surgery. J R Soc Med 1976;69:237–44.

    Google Scholar 

  24. Konishi F, Muto T, Takahashi H, Itoh K, Kanazawa K, Morioka Y. Transrectal ultrasonography for the assessment of invasion of rectal carcinoma. Dis Colon Rectum 1985;28:889–94.

    Google Scholar 

  25. Saitoh N, Okui K, Sarashina HI, Suzuki M, Arai T, Nunomura M. Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination. Dis Colon Rectum 1986;29:234–42.

    Google Scholar 

  26. Pahlmann L, Glimelius B. Local recurrences after surgical treatment for rectal carcinoma. Acta Chir Scand 1984;150:331–5.

    Google Scholar 

  27. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following “curative” surgery for large bowel cancer. Br J Surg 1984;71:17–20.

    Google Scholar 

  28. Wilking N, Herrera L, Petrelli NJ, Mittelmann A. Pelvic and perineal recurrences after abdominoperineal resection for adenocarcinoma of the rectum. Am J Surg 1985;150:561–3.

    Google Scholar 

  29. 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.

    Google Scholar 

  30. Wanebo HJ, Marcove RC. Abdominal sacral resection of locally recurrent rectal cancer. Ann Surg 1981; 194:458–70.

    Google Scholar 

  31. James RD, Johnson RJ, Eddleston B, Zheng GL, Jones JM. Prognostic factors in locally recurrent rectal carcinoma treated by radiotherapy. Br J Surg 1983; 70:469–72.

    Google Scholar 

  32. Ekman CA, Gusstavson J, Henning A. Value of a follow up study of recurrent carcinoma of the colon and rectum. Surg Gynecol Obstet 1978;145:895–7.

    Google Scholar 

  33. Hermaneck P, Gall FP, Altendorf A. Localrezidive nach Rektum-karzinom-Entstehung, Diagnose, Prognose. Langenbecks Arch Chir 1982;356:289–98.

    Google Scholar 

  34. Goligher JC. Surgery of the anus, rectum and colon. 5th ed. London: Bailliere Tindall, 1984.

    Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery and Organ Transplantation, University of Naples, Naples, Italy

    G. Romano M.D., L. Esercizio M.D., M. Santangelo M.D. & M. L. Santangelo M.D.

  2. 2nd Department of Radiology, 2nd Faculty of Medicine and Surgery, University of Naples, Naples, Italy

    G. Vallone M.D.

Authors
  1. G. Romano M.D.
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  2. L. Esercizio M.D.
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  3. M. Santangelo M.D.
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  4. G. Vallone M.D.
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  5. M. L. Santangelo M.D.
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Romano, G., Esercizio, L., Santangelo, M. et al. Impact of computed tomographyvs. intrarectal ultrasound on the diagnosis, resectability, and prognosis of locally recurrent rectal cancer. Dis Colon Rectum 36, 261–265 (1993). https://doi.org/10.1007/BF02053507

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