Locoregional recurrence of rectal cancer: biological and technical aspects of surgical failure.
The advantages of sphincter-saving treatment of rectal cancer are counterbalanced when local recurrences develop requiring abdominal-perineal excision of the rectum for salvage. Biological properties of the primary tumor contribute to this problem together with the surgeon's technique and overall oncological strategy. Adverse factors of the primary tumor are lymphatic, perineural, and venous invasion as well as mucinous type of adenocarcinoma and poor differentiation. Although tumor cells can adhere to suture material there is not sufficient evidence that the suture material contributes significantly to local relapse. Intraoperative tumor cell spillage is often provoked by the surgeon's technique in handling the tumor and the non-use of methods to prevent the seeding of exfoliated cells. Adequate operative techniques such as complete mesorectal excision, washing of rectal stump, and complete eradication of lymphatic spread of the tumor are prerequisites for low recurrence rates. Distal margins of clearance alone are of less importance than expected previously. Surgeons are the leaders in taking care of patients suffering from rectal cancer and they must apply their knowledge of tumor biological factors to their operative technique to avoid local recurrence of tumors.
Department of Surgery and Surgical Oncology, Robert Rössle Hospital, Charité Humboldt University of Berlin, Germany.
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Hohenberger
D006801:Humans; D008197:Lymph Node Excision; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000601:surgery*; D013514:Surgical Procedures, Operative; D013537:Sutures; D016896:Treatment Outcome