Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer: impact of patterns of pelvic recurrence on curative resection

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

The purpose of this study is to investigate prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer and determine whether recurrence patterns influence curative resection of recurrent tumor.

Materials and methods

We examined 62 patients with isolated local recurrence following total mesorectal excision (TME) of the primary rectal cancer. Recurrence patterns were classified as central, anterior, posterior, lateral, and perineal with respect to the intra-pelvic tumor location. Prognostic factors affecting oncologic outcomes were analyzed, and the rate of curative resection was analyzed according to recurrence patterns.

Results

The mean follow-up period was 49.0 ± 29.0 months, and the mean time to recurrence after TME was 27.9 ± 23.3 months. Twenty-three patients underwent curative resection, and the remaining 39 patients received palliative treatment. Patients with a central recurrence had the highest rate of curative resection (p = 0.006). The overall 5-year survival rate was 13.9% and significantly higher in those treated with curative resection (35.1%; p = 0.0002). Multivariate analysis demonstrated that disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors influencing 5-year survival.

Conclusion

Patients with central recurrences have a high probability of curative resection. Disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482 doi:10.1016/S0140-6736(86)91510-2

    Article  PubMed  CAS  Google Scholar 

  2. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460 doi:10.1016/0140-6736(93)90207-W

    Article  PubMed  CAS  Google Scholar 

  3. Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B (2002) Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Lancet 356:93–96 doi:10.1016/S0140-6736(00)02469-7

    Article  Google Scholar 

  4. Sagar PM, Pemberton JH (1996) Surgical management of locally recurrent rectal cancer. Br J Surg 83:293–304 doi:10.1002/bjs.1800830305

    Article  PubMed  CAS  Google Scholar 

  5. Enker WE, Merchant N, Cohen AM et al (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230:544–554 doi:10.1097/00000658-199910000-00010

    Article  PubMed  CAS  Google Scholar 

  6. Gagliardi G, Hawley PR, Hershman MJ, Arnott SJ (1995) Prognostic factors in surgery for local recurrence of rectal cancer. Br J Surg 82:1401–1405 doi:10.1002/bjs.1800821035

    Article  PubMed  CAS  Google Scholar 

  7. Cummings BJ, Rider WD, Harwood AR et al (1983) Radical external beam radiation therapy for adenocarcinoma of the rectum. Dis Colon Rectum 26:30–36 doi:10.1007/BF02554676

    Article  PubMed  CAS  Google Scholar 

  8. Danjoux CE, Gelber RD, Catton GE et al (1985) Combination chemoradiotherapy for residual, recurrent or inoperable carcinoma of the rectum: ECOG study (EST 3276). Int J Radiat Oncol Biol Phys 11:765–771

    PubMed  CAS  Google Scholar 

  9. Rhomberg W, Eiter H, Hergan K et al (1994) Inoperable recurrent rectal cancer: results of a prospective trial with radiation therapy and razoxane. Int J Radiat Oncol Biol Phys 30:419–425

    PubMed  CAS  Google Scholar 

  10. Salo JC, Paty PB, Guillem J, Minsky BD, Harrison LB, Cohen AM (1999) Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol 6:171–177 doi:10.1007/s10434-999-0171-8

    Article  PubMed  CAS  Google Scholar 

  11. Lowy AM, Rich TA, Skibber JM, Dubrow RA, Curley SA (1996) Preoperative infusional chemoradiation, selective intraoperative radiation, and resection for locally advanced pelvic recurrence of colorectal adenocarcinoma. Ann Surg 223:177–185 doi:10.1097/00000658-199602000-00010

    Article  PubMed  CAS  Google Scholar 

  12. Saito N, Koda K, Takiguchi N, Oda K, Ono M, Sugito M et al (2003) Curative surgery for local pelvic recurrence of rectal cancer. Dig Surg 20:192–200 doi:10.1159/000070385

    Article  PubMed  Google Scholar 

  13. Maetani S, Onodera H, Nishikawa T et al (1998) Significance of local recurrence of rectal cancer as a local or disseminated disease. Br J Surg 85:521–525 doi:10.1046/j.1365-2168.1998.00602.x

    Article  PubMed  CAS  Google Scholar 

  14. Mannaerts GH, Rutten HJ, Martijn H, Groen GJ, Hanssens PE, Wiggers T (2001) Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum 44:806–814 doi:10.1007/BF02234699

    Article  PubMed  CAS  Google Scholar 

  15. Hahnloser D, Nelson H, Gunderson LL et al (2003) Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 237:502–508 doi:10.1097/00000658-200304000-00011

    Article  PubMed  Google Scholar 

  16. Temple WJ, Ketcham AS (1991) Sacral resection for control of pelvic tumors. Am J Surg 163:370–374 doi:10.1016/0002-9610(92)90035-P

    Article  Google Scholar 

  17. Farouk R, Nelson H, Radice E, Mercill S, Gunderson L (1998) Accuracy of computed tomography in determining respectability for locally advanced primary or recurrent colorectal cancer. Am J Surg 175:283–287 doi:10.1016/S0002-9610(98)00017-8

    Article  PubMed  CAS  Google Scholar 

  18. Akasu T, Yamaguchi T, Fujimoto Y, Ishiguro S, Yamamoto S, Fujita S et al (2007) Abdominal Sacral Resection for posterior pelvic recurrence of rectal carcinoma: Analyses of prognostic factors and recurrence patterns. Ann Surg Oncol 14:74–83 doi:10.1245/s10434-006-9082-0

    Article  PubMed  Google Scholar 

  19. Lopez-Kostner F, Fazio VW, Vignali A, Rybicki LA, Lavery IC (2001) Locally recurrent rectal cancer; Predictors and success of salvage surgery. Dis Colon Rectum 44:173–178 doi:10.1007/BF02234289

    Article  PubMed  CAS  Google Scholar 

  20. Garcia-Aguilar J, Cromwell JW, Marra C, Lee SH, Madoff RD, Rothenberger DA (2001) Treatment of locally recurrent rectal cancer. Dis Colon Rectum 44:1743–1748 doi:10.1007/BF02234449

    Article  PubMed  CAS  Google Scholar 

  21. Park JK, Kim NK, Baik SH et al (2005) Local Pelvic Recurrence after Curative Resection of the Rectal Cancer: Classification and Prognosis. J Korean Soc Coloproctol 021:82–88

    Google Scholar 

  22. Bozzetti F, Bertario L, Rossetti C et al (1997) Surgical treatment of locally recurrent rectal carcinoma. Dis Colon Rectum 40:1421–1424 doi:10.1007/BF02070705

    Article  PubMed  CAS  Google Scholar 

  23. Wanebo HJ, Gaker DL, Whitehill R, Morgan RF, Constable WC (1987) Pelvic recurrence of rectal cancer; Options for curative resection. Ann Surg 205:482–495 doi:10.1097/00000658-198705000-00006

    Article  PubMed  CAS  Google Scholar 

  24. Shoup M, Guillem JG, Alektiar KM, Liau K, Paty PB, Cohen AM et al (2002) Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy. Dis Colon Rectum 45:585–592 doi:10.1007/s10350-004-6250-9

    Article  PubMed  Google Scholar 

  25. Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE (1984) Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 53:1354–1362 doi:10.1002/1097-0142(19840315)53:6<1354::AID-CNCR2820530623>3.0.CO;2-J

    Article  PubMed  CAS  Google Scholar 

  26. Suzuki K, Gunderson LL, Devine RM et al (1995) Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer 75:939–952 doi:10.1002/1097-0142(19950215)75:4<939::AID-CNCR2820750408>3.0.CO;2-E

    Article  PubMed  CAS  Google Scholar 

  27. Wanebo HJ, Antoniuk P, Koness RJ et al (1999) Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 42:1438–1448 doi:10.1007/BF02235044

    Article  PubMed  CAS  Google Scholar 

  28. Moore HG, Shoup M, Riedel E, Minsky BD, Alektiar KM, Ercolani M et al (2004) Colorectal cancer pelvic recurrences: Determinants of Resectability. Dis Colon Rectum 47:1599–1606 doi:10.1007/s10350-004-0677-x

    Article  PubMed  Google Scholar 

  29. Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T (2001) Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 88:988–993 doi:10.1046/j.0007-1323.2001.01811.x

    Article  PubMed  CAS  Google Scholar 

  30. Wells BJ, Stotland P, Ko MA, Al-Sukhni W, Wunder J, Ferguson P et al (2007) Results of an aggressive approach to resection of locally recurrent rectal cancer. Ann Surg Oncol 14:390–395 doi:10.1245/s10434-006-9119-4

    Article  PubMed  Google Scholar 

  31. Moriya Y, Akasu T, Fujita S, Yamamoto S (2004) Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancerin the pelvis. Dis Colon Rectum 47:2047–2054 doi:10.1007/s10350-004-0714-9

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by a grant from the Korean Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (0412-CR01-0704-0001, 0405-BC01-0604-0002).

Author information

Authors and Affiliations

  1. Department of Surgery, Kwan Dong University College of Medicine, Gyeonggi-do, Korea

    Jea-Kun Park

  2. Department of Surgery, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul, South Korea

    Young-Wan Kim, Hyuk Hur, Nam-Kyu Kim, Byung-Soh Min & Seung-Kook Sohn

  3. Department of Urology, Yonsei University College of Medicine, Seoul, South Korea

    Young-Deuk Choi

  4. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea

    Young-Tae Kim

  5. Department of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea

    Jung-Bai Ahn & Jae-Kyung Roh

  6. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea

    Ki-Chang Keum & Jin-Sil Seong

Authors
  1. Jea-Kun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young-Wan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyuk Hur
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nam-Kyu Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Byung-Soh Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seung-Kook Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Young-Deuk Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Young-Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jung-Bai Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jae-Kyung Roh
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ki-Chang Keum
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jin-Sil Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nam-Kyu Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Park, JK., Kim, YW., Hur, H. et al. Prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer: impact of patterns of pelvic recurrence on curative resection. Langenbecks Arch Surg 394, 71–77 (2009). https://doi.org/10.1007/s00423-008-0391-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-008-0391-6

Keywords

Search

Navigation