Long-Term Prognosis after Surgery for Locally Recurrent Rectal Cancer: A Retrospective Study.

Masato Nishimuta,Yorihisa Sumida,Ayako Shibuya,Masayuki Baba,Kouki Wakata,Shintaro Hashimoto,Tota Kugiyama,Masato Araki,Keisuke Ozeki,Shigeyuki Morino,Kiyoaki Hamada,Akihro Nakamura,Soichiro Kiya

doi:10.31557/apjcp.2021.22.5.1531

Masato Nishimuta, Yorihisa Sumida + Show 11 more

Open Access

https://doi.org/10.31557/apjcp.2021.22.5.1531

Copy DOI

Abstract

Objective:Resection is usually recommended for locally recurrent rectal cancer (LRRC) for which R0 resection is possible, but its suitability varies by individual patient risk. Here, we report outcomes of resected LRRC in our hospital. Methods:We retrospectively evaluated short- and long-term results of 33 patients who underwent resections for LRRC from January 2003 to December 2019. Results:At the initial surgeries for these 33 patients, their disease stages at that time were Stage I: n=2, Stage II: n=12, Stage III: n=11, Stage IV: n=6, and unknown: n=2. Patients with Stage IV disease at their initial surgeries underwent radical one-step or two-step procedures. Metastasis to other organs was observed in 5 patients at the their initial LRRC diagnoses. At the LRRC surgeries, 7 patients received palliative surgeries; 26 received intent-to-treat resections, of which 17 were R0 resections. All-grade postoperative complications were observed in 11 patients, including 1 surgery-related death. Five-year overall survival rates were all cases: 38.4%; R0 group: 52.3%, R1 or R2 group: 19.4%, and palliative surgery group: 0%. The R0 group thus had significantly better prognosis than other patients (P = 0.0012). Eleven patients in the R0 group (64.7%) suffered re-recurrences but some patients achieved long-term survival through chemotherapy, radiation therapy, and surgery for metastasis to other organs, even after re-recurrence. Conclusion:Long-term prognosis after surgery for LRRC was significantly better for patients with R0 margins. Multimodal treatments may greatly improve survival for patients who suffer re-recurrences after local recurrence resections.

Highlights

Local recurrence of rectal cancer (LRRC) after radical surgery is relatively common (Kobayashi et al.,2007), and is usually treated with R0 resection (The curative resection was defined as R0 resection.) (Bhangu et al, 2012)
Resection is usually recommended for locally recurrent rectal cancer (LRRC) for which R0 resection is possible, but its suitability varies by individual patient risk
For all Stage IV cases, R0 surgery was performed by resection of distant metastases in one- or two-step surgeries

Summary

Introduction

Local recurrence of rectal cancer (LRRC) after radical surgery is relatively common (Kobayashi et al.,2007), and is usually treated with R0 resection (The curative resection was defined as R0 resection.) (Bhangu et al, 2012). Radical resection for LRRC must be carefully considered, as it is highly invasive, has a high postoperative complication rate, and has a large effect on the postoperative quality of patients’ lives (such as the need for artificial anus). Use of multimodal treatments besides surgery for LRRC is increasing. We have been actively performing resections for LRRC except for sacral resections. We have analyzed patients’ short-term and long-term outcomes to better inform our treatment policy for LRRC

Methods

Results

Conclusion