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Curative reoperations for locally recurrent rectal cancer

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Our aims were to determine the morbidity, survival and its influencing factors, and patterns of failure for patients who underwent further surgery with the hope of cure for locally recurrent rectal cancer. METHODS: Between January 1981 and December 1988, 224 patients with a preoperative diagnosis of recurrent rectal cancer underwent additional surgery at Mayo Medical Center in Rochester, Minnesota. Of these, 65 underwent further surgery with the hope of cure,i.e.,no gross/microscopic residual disease at tumor margins after reoperation. Factors assessed included type of original operation, time interval between operation for primary tumor and initial operation for recurrence, symptom status, degree of fixation, types of reoperations for recurrence, and adjuvant therapy. RESULTS: None of the patients died within 30 days of reoperation. Seventeen complications requiring hospitalization and/or surgical procedure were observed in 14 patients. Extended operations (involving partial or complete removal of surrounding organs/structures) required more time to perform, a greater number of transfusions, and a longer hospital stay than more limited operations. Three-year, five-year, and median survival were 57, 34, and 44.7 months, respectively. Survival was greater after curative than after palliative resection (P<0.001). Survival tended to be greater in females (P<0.075) and in patients without pain (P<0.065). Cumulative probability of local failure was 24, 41, and 47 percent at 1, 3, and 5 years, respectively. Cumulative risk of distant metastasis was 30, 51, and 62 percent at 1, 3, and 5 years, respectively. CONCLUSIONS: Our results indicate that complete excision of locally recurrent rectal cancer can provide a significant number of patients with long-term survival and can be accomplished safely in select patients.

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References

  1. Dunphy JE. Recurrent cancer of the colon and rectum: report of cases with favorable results following radical surgery. N Engl J Med 1947;237:111–3.

    Article  CAS  PubMed  Google Scholar 

  2. Black BM, Kelly AH. Recurrent carcinoma of the rectum and rectosigmoid: results of treatment after continencepreserving procedures. Arch Surg 1955;71:538–42.

    CAS  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  4. Polk HC Jr, Spratt JS Jr. Recurrent colorectal carcinoma: detection, treatment, and other considerations. Surgery 1971;69:9–23.

    PubMed  Google Scholar 

  5. Wangensteen OH, Lewis FJ, Arhelger SW, Muller JJ, Maclean LD. An interim report upon the “second look” procedure for cancer of the stomach, colon, and rectum and for “limited intraperitoneal carcinosis.” Surg Gynecol Obstet 1954;99:257–67.

    CAS  PubMed  Google Scholar 

  6. Steele G, Zamcheck N, Wilson R,et al. Results of CEA-initiated second-look surgery for recurrent colorectal cancer. Am J Surg 1980;139:544–8.

    PubMed  Google Scholar 

  7. Martin EW Jr, Minton JP, Carey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 1985;202:310–7.

    Article  PubMed  Google Scholar 

  8. Staab HJ, Anderer FA, Stumpf E, Hornung A, Fischer R, Kieninger G. Eighty-four potential second-look operations based on sequential carcinoembryonic antigen determinations and clinical investigations in patients with recurrent gastrointestinal cancer. Am J Surg 1985;149:198–204.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  10. Vassilopoulos PP, Yoon HN, 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.

    CAS  PubMed  Google Scholar 

  11. 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 

  12. Umpleby HC, Williamson RC. Anastomotic recurrence in large bowel cancer. Br J Surg 1987;74:873–8.

    CAS  PubMed  Google Scholar 

  13. Gunderson LL, Sosin H. Areas of failure found at reoperation (second of symptomatic look) following “curative surgery” for adenocarcinoma of the rectum: clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.

    CAS  PubMed  Google Scholar 

  14. Emami B, Pilepich M, Willett C, Munzenrider JE, Miller HH. Effect of preoperative irradiation on resectability of colorectal carcinomas. Int J Radiat Oncol Biol Phys 1982;8:1295–9.

    CAS  PubMed  Google Scholar 

  15. Dosoretz DE, Gunderson LL, Hedberg S,et al. Preoperative irradiation for unresectable rectal and rectosigmoid carcinomas. Cancer 1983;52:814–8.

    CAS  PubMed  Google Scholar 

  16. 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.

    CAS  PubMed  Google Scholar 

  17. Ghossein NA, Samala EC, Alpert S,et al. Elective postoperative radiotherapy after incomplete resection of colorectal cancer. Dis Colon Rectum 1981;24:252–6.

    CAS  PubMed  Google Scholar 

  18. Taylor RE, Kerr GR, Arnott SJ. External beam radiotherapy for rectal adenocarcinoma. Br J Surgery 1987;74:455–9.

    CAS  Google Scholar 

  19. Allee PE, Tepper JE, Gunderson LL, Munzenrider JE. Postoperative radiation therapy for incompletely resected colorectal carcinoma. Int J Radat Oncol Biol Phys 1989;17:1171–6.

    Article  CAS  Google Scholar 

  20. Suzuki K, Gunderson LL, Devine RM,et al. Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer 1995;27:939–52.

    Google Scholar 

  21. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.

    Google Scholar 

  22. Peto R, Peto J. A symptotically efficient rank invariant procedures. J R Stat Soc 1972;135:185–207.

    Article  Google Scholar 

  23. Pilipshen SJ. Current therapy in colon and rectal surgery. In: Fazio VW, ed. Cancer of the rectum: local recurrence on current therapy in colon and rectal surgery. Toronto: BC Decker, 137–49.

  24. Vons C, Houry S, Lacaine F, Huguier M. Treatment of local recurrence after primary restorative resection or Hartmann's operation for carcinoma of the colon and rectum. Int J Colorectal Dis 1986;1:227–30.

    CAS  PubMed  Google Scholar 

  25. Wanebo HJ, Gaker DL, Whitehill R, Morgan RF, Constable WC. Pelvic recurrence of rectal cancer: options for curative resection. Ann Surg 1987;205:482–95.

    CAS  PubMed  Google Scholar 

  26. Takagi H, Morimoto T, Kato T, Yasue M, Endo T, Suzuki R. Pelvic exenteration combined with sacral resection for recurrent rectal cancer. J Surg Oncol 1983;24:161–6.

    CAS  PubMed  Google Scholar 

  27. Magrini S, Nelson H, Gunderson LL, Sim FH. Sacropelvic resection and IORT in the management of recurrent rectal and anal cancers [meeting abstract]. Dis Colon Retum 1995;38:P20.

    Google Scholar 

  28. Orkin BA, Dozois RR, Beart RW Jr, Patterson DE, Gunderson LL, Ilstrup DM. Extended resection for locally advanced primary adenocarcinoma of the rectum. Dis Colon Rectum 1989;32:286–92.

    CAS  PubMed  Google Scholar 

  29. Sugarbaker PH, Attihey FF, Ellis H,et al. The management of recurrent colorectal cancer. Int J Colorectal Dis 1986;1:133–51.

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  31. Dozois RR, Perry RE. Rectal cancer: current management. Curr Probl Surg 1990;28:243–99.

    Google Scholar 

  32. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding JP. Local recurrence following “curative” surgery for large cancer: the overall picture. Br J Surg 1984;71:12–6.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  34. Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8.

    CAS  PubMed  Google Scholar 

  35. Berger A, Tiret E, Parc R,et al. Excision of the rectum with colonic J-pouch-anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg 1992;16:470–7.

    CAS  PubMed  Google Scholar 

  36. Cavalieri F, Pemberton JH, Cosimelli M, Fazio VW, Beart RW Jr. Coloanal anastomosis for rectal cancer: longterm results at the Mayo and Cleveland Clinics. Dis Colon Rectum 1995;38:807–12.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street, Southwest, 55905, Rochester, Minnesota

    Kimitaka Suzuki M.D.,  Roger R. Dozois M.D., Richard M. Devine M.D., Heidi Nelson M.D., Amy L. Weaver M.S., Leonard L. Gunderson M.D. & Duane M. Ilstrup M.S.

  2. Division of Radiation Oncology, Rochester, Minnesota

    Kimitaka Suzuki M.D.,  Roger R. Dozois M.D., Richard M. Devine M.D. & Heidi Nelson M.D.

  3. Department of Health Sciences Research, Rochester, Minnesota

    Leonard L. Gunderson M.D.

  4. Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Amy L. Weaver M.S. & Duane M. Ilstrup M.S.

Authors
  1. Kimitaka Suzuki M.D.
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  2. Roger R. Dozois M.D.
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  3. Richard M. Devine M.D.
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  4. Heidi Nelson M.D.
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  5. Amy L. Weaver M.S.
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  6. Leonard L. Gunderson M.D.
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  7. Duane M. Ilstrup M.S.
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Additional information

Supported in part by GI Program Project Grant CA 31224.

Read in part at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.

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Suzuki, K., Dozois, R.R., Devine, R.M. et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum 39, 730–736 (1996). https://doi.org/10.1007/BF02054435

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  • DOI: https://doi.org/10.1007/BF02054435

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