Abstract
BackgroundRectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis.MethodsWe performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR.ResultsDuring the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy.ConclusionsThe benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.
Highlights
Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%
local recurrence (LR) affected 11 (6%) of the patients treated with RT
Our analysis showed that colonoscopy was a good method for diagnosing recurrent rectal cancer in the anastomosis; it did not provide advantages over other diagnostic methods for diagnosing LR in patients who did not receive RT (P > 0.05 for both types of recurrences; Table 5)
Summary
One of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. Colorectal cancer (CRC) is one of the most common malignancies worldwide. Most patients with CRC will undergo radical. Jankowski et al World J Surg Onc (2021) 19:308 treatment for the disease; they represent the third largest group of long-term cancer survivors [2]. At least 30% of CRCs are located in the rectum [3]. In 2017, 5617 Polish patients were diagnosed with cancer of the rectum and rectosigmoid junction [4]. Poland belongs to the group of countries with a medium risk of CRC, and the number of cases and cancer-related deaths is constantly increasing [1, 4]
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