[Surgical treatment of recurrent locoregional rectal cancer].
Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially if surgery is sub-optimal (without total excision of the mesorectum). In many cases, diagnosis of LR is made at a late stage because of the high rate of asymptomatic patients, 56% in the experience of the Mayo Clinic. MRI and PETscan are most effective for assessing local and general extension, with a high diagnostic accuracy. Surgical treatment alone or with radiation (preoperative and/or intraoperative) is the only curative treatment of LR with R0 resectability rates of 30% to 45%. Morbidity and mortality rates are high, especially for total exenteration and abdomino-sacral resection. After curative surgery, 5-year global survival is between 30% and 40%. Palliative resection of macroscopic residues is not recommended. Careful patient selection for curative surgery is the best way to optimize treatment in these cases.
Ghouti
Laurent
L
Service de Chirurgie Digestive et Oncologique, Hôpital Purpan, Toulouse. ghouti.l@chu-toulouse.fr
Portier
Guillaume
G
Kirzin
Sylvain
S
Guimbaud
Rosine
R
Lazorthes
Franck
F
D003082:Colectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D010385:Pelvic Exenteration / Q000401:mortality; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016019:Survival Analysis