Treatment strategy for locally recurrent rectal cancer.
Despite radical surgery, up to 33% of patients with rectal cancer will develop locoregional relapse. The management of these patients is particularly challenging. Surgery is the mainstay of treatment for those with a mobile recurrence. However, the majority of patients develop recurrence involving the pelvic wall. In these patients, multimodality therapy including radical surgery and intraoperative radiotherapy have been reported with 5-year survival of up to 31% and local control rates of 50-71%. The most important factor for obtaining long-term local control and survival is R0 resection. Extended surgery such as abdomino-sacral resection has not been popular because of 5-year survival rates of 16-31%, and significant postoperative morbidity. Re-recurrence following surgery occurs locally and in the lung, and remains a significant problem. In surgical treatment for local recurrence, surgeon-related factors are crucial. A staging system using degree of fixation and other prognostic factors should be developed so that appropriate treatment modalities are applied to each case.
Moriya
Yoshihiro
Y
Colorectal Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan. ymoriya@ncc.go.jp
D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D010385:Pelvic Exenteration; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome