The role of surgical management of locally recurrent rectal cancer(LRRC)

Abstract

3712 Background: Use of salvage surgery in the treatment of recurrent rectal cancer is controversial because of the poor overall survival and the morbidity relevant to extirpative surgery in such patients. Methods: Twenty nine patients treated by surgery with curative intent for LRRC from 1998 to 2004 were analyzed. Postopearative morbidity, mortality and prognosis were analyzed. Median follow up time after salvage surgery was 33.2months (range, 1 to 80.8months). Results: Patient backgrounds: Surgery for primary tumor; abdominoperineal resection(APR) 16cases/Low anterior resection 13cases, Dukes stage; A 1/B 16/C 10/unknown 2, Adjuvant therapy after primary surgery; none 5/systemic chemotherapy 17/unknown 7, The surgical management of recurrent tumor included 3 APR, 4 abdominosacral resection, 13 total or posterior pelvic exenteration with/without sacral resection, and 9 local tumor excision. Curative operation (R0) was performed in 23 patients. Median operative time was 885 minutes (range, 130 to 1500 min.). Median estimated blood loss was 5550 ml (range, 310 to 60600 ml.). Postoperative mortality is 1/29(3.4%). Nineteen patients suffered perioperative complications. The morbidity included perineal wound infection (n=8, 27%), pelvic cavity infection (n=6, 21%), bowel obstruction (n=3, 14%), urinary tract disorder (infection, stenosis of ureter, dysfunction) (n=10, 34%), perioperative hemorrhage (n=2, 6.9%). The median overall survival after local recurrence was 20.1 months. Survival rate in patients with concomitant distant metastasis (n=5) after 1 and 3 years is 100% and 37.5%, respectively, and survival rate without concomitant distant metastasis (n=24) is 95.5% and 56.6% respectively. Conclusions: Surgical management of LRRC can be performed safely with low mortality, but still carries a significant morbidity. Our results are in agreement with other international literature data and further follow up is needed to justify this treatment. No significant financial relationships to disclose.