title: Resection of locally recurrent colorectal cancer in the presence of distant metastases: can it be justified?
abstract: BACKGROUND
  We aimed to determine the outcome of resections for local recurrence of colorectal carcinoma in the presence of distant (M1) disease.
  
  
  METHODS
  Patients who underwent resection of local recurrence in the presence of potentially resectable M1 disease were identified from the colorectal database. Outcome was determined by chart review.
  
  
  RESULTS
  Forty-two patients (23 men) of mean age 60 years (range, 34-88 years) underwent complete gross resection of their local recurrence in the presence of M1 disease. Thirteen of the 42 underwent synchronous M1 resections to render them free of gross disease (R0). Nine of the 29 patients who left with residual disease (R1) subsequently underwent staged M1 resection, so that 22 of 42 were rendered R0 by surgery. The median survival of all patients was 14.5 months (interquartile range, 6-30 months), and that of patients rendered R0 was 23 months (interquartile range, 10-37 months), in comparison with 7 months (interquartile range, 3-25 months) for those of R1 status (P =.006; log-rank method). Ability to achieve R0 status by synchronous or staged resection was the only factor predictive of survival.
  
  
  CONCLUSIONS
  The presence of M1 disease per se should not preclude resection of local recurrence, although case selection is problematic.
authors.affiliation: Colorectal Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Hartley
authors.forename: R A
authors.initials: RA
authors.lastname: Lopez
authors.forename: P B
authors.initials: PB
authors.lastname: Paty
authors.forename: W D
authors.initials: WD
authors.lastname: Wong
authors.forename: A M
authors.initials: AM
authors.lastname: Cohen
authors.forename: J G
authors.initials: JG
authors.lastname: Guillem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D013534:Survival; D016896:Treatment Outcome