Prognostic factors after surgical treatment for locally recurrent distal rectal cancer

Denis Aslan,Cristian Balalau,Ileana Popa,Adrian Bordea,Razvan Scaunasu,Traean Burcos

doi:10.37897/rjmp.2016.4.9

Abstract

Objectives. Local recurrence after distal rectal cancer surgery is a major complication with an increased morbidity and mortality. The therapeutic strategy consists in a complex association of radiochemotherapy with surgical approach that may improve prognosis and quality of life. It is necessary to identify the risk factors for local recurrence and to have a highly-selected patients for oncological radical treatment. Materials and methods. The study included the analysis of 79 patients with middle and lower rectal cancer who were diagnosed and operated at Coltea Clinic Surgical Clinic Hospital, Bucharest, for a period of 4 years. Male patients were more frequent (64.4%). The average age was 65 years old. The surgical strategy included 33 patients (41.8%) who underwent abdominoperineal resection, 36 patients (45.6%) who underwent low anterior resection with stapled colorectal anastomosis and 10 patients (12.75) who underwent ultralow anterior resection. Results. Local recurrence rate was 12.7%. The mean time from surgery until the time of discovery of local recurrence was 14.5 months. Local recurrence was associated with advanced tumor stages T3 (10.1%) and T4 (2.5%). It was also associated with histopathological features related to serous infiltration (100%) and tumor invasion of the radial margins (3.8%). The surgical treatment strategy consisted of abdominoperineal resection, permanent colostoma and R2 resections. Discussion. The radical surgical resection is the most significant prognostic factor. There are a number of other patient-related factors and tumor-related factors that can significantly influence the evolution and overlall survival. Periodic clinical, imaging scans and colonoscopy follow-ups are able to early detect the tumor recurrence and to allow a curative cancer treatment. Conclusions. Local recurrence after mid and lower rectal cancer surgery is a major complication with direct impact on morbidity, mortality, prognosis and quality of life of these patients. The treatment strategy must be established by a multidisciplinary team in order to identify carefully-selected patients to undergo the optimal oncological therapy.

Highlights

Recurrent rectal cancer is a major complication that occurs following primary resection of distal rectal cancer with increased morbidity and mortality rates
The basic principle in rectal cancer surgery is the “en-bloc” resection of the rectum surrounded by the intact mesorectum and perirectal fascia, following the embryological “Holy Plane” discovered by R
He had introduced the concept of sharp-dissection in well lighted field, using optimal retractors to open the deep pelvis and following an avascular plane that will resect a cillindrical shape specimen containg the intact rectum and mesorectum

Summary

Introduction

Recurrent rectal cancer is a major complication that occurs following primary resection of distal rectal cancer with increased morbidity and mortality rates. 33% of patients with rectal cancer will develop locoregional recurrence [1]. The basic principle in rectal cancer surgery is the “en-bloc” resection of the rectum surrounded by the intact mesorectum and perirectal fascia, following the embryological “Holy Plane” discovered by R. Heald in 1982 [3,10] He had introduced the concept of sharp-dissection in well lighted field, using optimal retractors to open the deep pelvis and following an avascular plane that will resect a cillindrical shape specimen containg the intact rectum and mesorectum. The neoadjuvant radiochemotherapy may have a clinical response by tumor “downstaging” and allows the patients who benefit of preoperative chemoradiation to undergo anal sphincter preservation surgery with a major impact on the quality of life [11]

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Results