Early and Late Outcomes of Surgery for Locally Recurrent Rectal Cancer: A Prospective 10-Year Study in the Total Mesorectal Excision Era.

Abstract

The aim of this study was to assess the outcome of all locally recurrent rectal cancer (LRRC) patients who were referred to a tertiary care center. The study examined LRRC patients who underwent surgery after prior total mesorectal excision. The data of 213 consecutive LRRC patients who were registered in a database between 2001 and 2010 were accessed. A total of 115 patients (54%) with a median age of 63 (range 34-81) years underwent tumor resection. The 30-day mortality rate was 0.8% (95% CI 0.02-4%), and the complication rate was 42% (95% CI 33-51%). R0 resection was achieved in 70 patients (61%), R1 resection in 38 patients (33%), and R2 resection in 7 patients (6%). The 3- and 5-year survival rates for R0 resections were 55% (95% CI 41-66) and 40% (95% CI 26-53), respectively; 42% (95% CI 26-58) and 16% (95% CI 5-31), respectively, for R1 resections; no patients who received an R2 resection survived to the 3-year mark. Patients with prior abdominoperineal excision (APE) had significantly poorer survival rates than patients with prior resection with anastomosis (p=0.02). Acceptable long-term survival can be achieved for patients undergoing surgery for LRRC, but radical resection is mandatory. Prior APE was associated with poorer survival rates.