PM02 RECURRENT RECTAL CANCER – STRATEGIES FOR PAIN MANAGEMENT

Abstract

Introduction Despite improvement in management of primary rectal cancer, local recurrence remains a significant problem. The aim was to address strategies for pain management in patients with recurrent rectal cancer.Methods A literature search was performed using Medline, Embase, Ovid, and Cochrane database for studies between 1980 and 2005 assessing pain management of local recurrence of rectal cancer and the evidence was critically evaluated in the light of clinical experience in tertiary colorectal centres.Results Nearly 50% of rectal cancer pelvic recurrences are local and are therefore potentially amenable to curative resection. Preoperative imaging with MRI and PET is essential for appropriate selection of patients for surgery and preoperative adjuvant therapy is important. Five year survival following resection ranges from 18%–58% though morbidity ranges from 21% to 82%. Palliative resection is usually inappropriate. Radiotherapy has an important role in the local control of irresectable local disease. Pain management of advanced pelvic disease, particularly with sacral nerve root invasion, remains difficult and often necessitates a multidisciplinary and multimodality approach. Aggressive surgical treatment favourably affects quality of life and is cost effective for irresectable local disease.Discussion Surgery for local recurrence can result in significant survival with acceptable morbidity and improved quality of life in appropriately selected patients. Pain management of advanced pelvic recurrence is complex and should be multidisciplinary.