Document Detail


Multimodality salvage of recurrent disease after local excision for rectal cancer.
MedLine Citation:
PMID:  23135578     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Local excision, alone or in combination with chemoradiation, is increasingly considered for rectal cancer. Higher risks of disease recurrence have been demonstrated after local excision.
OBJECTIVE: The aim of this study was to examine the outcomes of current-era multimodality salvage for recurrent rectal cancer after local excision.
DESIGN: This was a single-institutional retrospective study.
SETTINGS: This study was conducted at a tertiary-referral cancer center between 1993 and 2011.
PATIENTS: Forty-six patients with recurrent rectal cancer after initial local excision were included.
INTERVENTION: Multimodality salvage treatment was performed as appropriate.
MAIN OUTCOME MEASURES: The primary outcomes measured were the pattern of disease recurrence, salvage treatments, and resultant overall and re-recurrence-free survival.
RESULTS: After the initial local excision, recurrent disease was diagnosed after a median interval of 1.9 years: local/regionally in 67%, distantly in 18%, and both in 15%. Four patients (9%) had recurrence that was unsalvageable, 2 (4%) declined treatment, and 40 (87%) underwent surgical salvage. Preoperative chemoradiation was given in 30 (75%) patients. The R0 resection rate was 80%, requiring multivisceral resection (33%), total pelvic exenteration (5%), and metastasectomy (25%). The rate of sphincter preservation was 33%, and perioperative morbidity was 50%. The first site of failure after salvage was distant in 38% and was local only in 10%. The 5-year overall and 3-year re-recurrence-free survival were 63% and 43%. Pathologic stage at initial local excision, receipt of neoadjuvant chemoradiation before local excision, recurrence pattern after local excision, pathologic stage at salvage, and R0 resection at salvage influenced re-recurrence-free survival.
LIMITATIONS: This study was limited by the referral and selection biases inherent in a small study cohort.
CONCLUSIONS: Failure after local excision for rectal cancer may not be salvageable. When feasible, multimodality treatment, including multivisceral resection, pelvic irradiation, and chemotherapy, was associated with potentially lasting treatment-related morbidities and only modest success in long-term disease control. These findings should be compared with the expected stage-specific outcomes of standard proctectomy for early-stage rectal cancer, when local excision is being considered.
Authors:
Y Nancy You; Robert E Roses; George J Chang; Miguel A Rodriguez-Bigas; Barry W Feig; Rebecca Slack; Sa Nguyen; John M Skibber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  2013-02-11     Revised Date:  2013-05-08    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1213-9     Citation Subset:  IM    
Affiliation:
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-4008, USA. ynyou@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local / pathology,  therapy*
Neoplasm Staging
Postoperative Complications
Rectal Neoplasms / pathology,  surgery*
Retrospective Studies
Salvage Therapy / methods*
Survival Rate
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K07 CA133187/CA/NCI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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