The Effect of Surgical Treatment for Local Recurrence after Rectal Cancer Surgery: An Analysis based on the Preoperative Imaging Studies

Kazunari Misawa, Tomoyuki Kato, Yukihide Kanemitsu, Koji Komori and Takashi Hirai

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital

Background: Although surgical resection is the only therapeutic option for curing patients with local recurrence after rectal cancer surgery, the dismal prognosis often fails to justify the degree of adverse events associated with major surgery. To reassess the relevance of surgery, we analyzed the outcome of patients based on the site or extent of local recurrence classified based on preoperative imaging studies. Patients and Methods: Between 1981 and 2002, 84 patients with locally recurrent rectal cancer underwent curative surgery. They were classified into three groups based on the preoperative computed tomography or magnetic resonance imaging: recurrent tumors invading or touching the piriform muscles or internal obturator muscles, or touching the upper sacrum (S1, S2) (group A); recurrent tumors invading or touching the lower sacrum (S3, S4, S5) or the pelvic organs such as the prostate, the uterus, the seminal vesicles or the urinary bladder (group B); and recurrent tumors localized at the anastomosis site (group C). Prognostic data for 19 patients diagnosed during the same period who were found to have extensive tumoral invasion and were not indicated for surgery or failed to undergo resection were used for comparison (nonresection group). Results: Curative resection in all patients was 61.9%. That in group A was 31.8%, in group B 80.6%, and in group C 81.3%. Five-year survival following resection was 30.0% in all patients, 5.9% in group A, 32.7% in group B, and 67.0% in group C. The incidence of locoregional failure and distant metastasis following surgery for recurrent disease was significantly higher for Group A. The median interval between primary diagnosis of local recurrence and detection of distant metastasis was 8.4 months for group A and 18.0 months for the nonresection group, although no difference in overall survival was observed between the two groups. Conclusions: Patients in group A suffered from poor curative resection and early emergence of locoregional failure or distant metastasis, leading to a dismal prognosis. The indication for surgery, the optimal extent of surgical resection, and the application of adequate adjuvant therapies should therefore be seriously reconsidered for this subset of patients.

Key words
rectal cancer, surgery, local recurrence, site of local recurrence, preoperative imaging studies

Reprint requests
Kazunari Misawa Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
April 26, 2006

To read the PDF file you will need Abobe Reader installed on your computer.