Local Recurrence Of Rectal Cancer Research Articles

Seven cases of pelvic exenteration combined with sacral resection for locally recurrent rectal cancer.

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Carcinoembryonic antigen assay is valuable for diagnosing most recurrent rectal cancers, but it is inadequate for early detection. Pelvic computed tomography examination is very valuable for the early detection and localization of recurrence in relation to pelvic structures and can also serve as a guide in percutaneous needle biopsy of the tumor. Seven patients with deeply invading recurrent lesions underwent pelvic exenteration combined with sacral resection. The ileal segment conduit was used for ureteral urinary diversion. The mean operation time and blood loss were 8.8 hours and 6,200 ml, respectively. No operative deaths were encountered. One patient is alive 22 months postoperatively with no evidence of disease, and another patient is alive 32 months postoperatively with pelvic wall recurrence. This procedure seems a reasonable treatment for palliation and full recovery in certain patients.

Diagnosis and operation for locally recurrent rectal cancer.

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Six patients with deeply invading recurrent lesions had pelvic exenteration combined with sacral resection. This procedure seems a reasonable treatment for palliation and the chance of cure in selected patients. In order to select good candidates for this extensive procedure, carcinoembryonic antigen (CEA) assays and the diagnosis of locally recurrent tumor with pelvic computed tomography (CT) were evaluated. CEA assay is valuable for diagnosing most recurrent rectal cancers, but it is inadequate for early detection. A high CEA level often indicates extrapelvic tumor spread. CT examination is very valuable for the early detection and localization of recurrence in relation to pelvic structures.

Pelvic Exenteration Combined With Sacral Resection for Recurrent Rectal Cancer

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Computed tomographic (CT) study of the pelvis revealed recurrent tumor images in relation to the adjacent pelvic structures. Five patients with deeply invading recurrent lesions were submitted to pelvic exenteration combined with sacral resection. No postoperative deaths were encountered. The postoperative sharp drops of serum CEA levels are useful for judging the adequacy of this procedure. The follow-up status of the 5 patients, respectively: 14 months alive with pulmonary metastasis, 9 months alive without symptoms but with slightly elevated CEA levels, and 8 months, 3 months, and 3 weeks alive with no evidence of disease. All patients who were relieved of perineal or sciatic nerve pain are now able to walk without any assistance or trouble. Total en bloc residual pelvic exenteration combined with sacral resection is a reasonable treatment for locally recurrent rectal cancer.

Pelvic exenteration combined with sacral resection for recurrent rectal cancer

Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Computed tomographic (CT) study of the pelvis revealed recurrent tumor images in relation to the adjacent pelvic structures. Five patients with deeply invading recurrent lesions were submitted to pelvic exenteration combined with sacral resection. No postoperative deaths were encountered. The postoperative sharp drops of serum CEA levels are useful for judging the adequacy of this procedure. The follow-up status of the 5 patients, respectively: 14 months alive with pulmonary metastasis, 9 months alive without symptoms but with slightly elevated CEA levels, and 8 months, 3 months, and 3 weeks alive with no evidence of disease. All patients who were relieved of perineal or sciatic nerve pain are now able to walk without any assistance or trouble. Total en bloc residual pelvic exenteration combined with sacral resection is a reasonable treatment for locally recurrent rectal cancer.

The effectiveness of wide anatomical resection and radical lymphadenectomy for patients with rectal cancer

The results of wide anatomical resection and radical lymphadenectomy which we termed the extended operation were examined. Materials consisted of 160 Japanese patients who underwent conventional operation during 1962-1968 prior to the introduction of extended operation, 113 patients who underwent extended operation since 1969, and 119 patients who underwent conventional operation from 1969 to 1976. The cumulative 5-year survival rates were 70% (1962-1968) and 67.8% (1969-1976) for the conventional operation groups and 90.3% for the extended operation group in Dukes B group (p less than 0.05). In Dukes C group, the rates were 26.3% (1962-1968) and 37.8% (1969-1976) for the conventional operation groups and 51.6% for the extended operation group. The incidences of local recurrence in Dukes B group were 25% (1969-1976) in the conventional operation group and 6.5% in the extended operation group, while in Dukes C group the rates were 45.0% (1969-1976) and 25% respectively. Our study demonstrated that the extended operation resulted in a decrease in the local recurrence of rectal cancer and prognosis. We therefore recommend that extensive surgery be planned for advanced cases of rectal cancer.

Abdominal sacral resection of locally recurrent rectal cancer.

Local recurrence of rectal cancer develops in the posterior bony pelvis as an isolated event in about half of the patients with recurrence. Although radiation can palliate sacral root pain, the disease is usually progressive and is rarely amenable to conventional resection. We have adapted a surgical technique usually used for primary sacral tumors, which permits a complete en bloc excision of recurrent rectal cancer in most instances. This approach consists of a laparotomy with pelvic dissection and mobilization of structures to be resected. The patient is repositioned prone and the posterior pelvis (sacrum and side walls) is then resected with preservation of appropriate nerve roots of the posterior pelvis and the sciatic nerve. Reconstruction is done with muscle and skin flaps. We have done 21 such procedures, of which, 11 were for pelvic recurrence of rectal adenocarcinoma. Seven patients had resections for cure and four had palliative resections of fungating or infected tumors. All but one patient was postabdominal perineal resection and nine patients had been irradiated (3000-9000 rads). Two patients had received up to 9000 rads in separate courses (external beam in one and interstitial radiation in the other). The posterior extent of resection was S1-2 to 5 in six patients; S3 to 5 in three patients, and S4-5 in two patients. Anterior exenteration was performed in three patients and three patients had additional resection of other organs. In the curative resection group, three patients are living free of disease at six, ten, and 52 months, and one patient was NED at 60 months, but has again had tumor recurrance and is living with disease at 65 months. One patient died of disease at 13 months and one patient died of a pulmonary embolus following resection for ureteral obstruction at five months. One postoperative death occurred from a cerebrovascular accident at 52 days. In the palliative resection group, three patients survived with relief of local tumor symptoms four, eight, and 12 months. One patient who had received a total of 9000 rads developed flap necrosis, small bowel fistula and died 60 days after resection. Although this is a small series, it suggests that abdominal sacral resection of locally advanced pelvic cancer is feasible and may provide good palliation in most and possible cure in some patients who develop recurrence after primary resection of adenocarcinoma of the rectum.