Extended radical resection: the choice for locally recurrent rectal cancer.
OBJECTIVE
Surgery for recurrent rectal cancer is the only therapy with curative potential. This study was designed to assess factors that affect survival after surgery for locally recurrent rectal cancer.


METHODS
Prospective databases of patients undergoing surgical resection for recurrent rectal cancer at three tertiary centers between 1990 and 2006 were combined and analyzed. Cox regression and Kaplan-Meier survival analysis were used to assess factors associated with survival.


RESULTS
A total of 160 patients (96 males) underwent surgery (median age, 63 (range, 27-93) years). Ninety-five patients (59 percent) received neoadjuvant radiotherapy. Sixty-three patients (39 percent) underwent radical resection and 90 (56 percent) underwent extended radical resection. Seven patients (5 percent) were irresectable. There was one death and 27 percent had major postoperative complications, independent of extent of resection. Negative resection margins were obtained in 98 patients (R0 61 percent). Median cancer-specific and overall survival was 48 months (41.5 percent 5-year survival) and 43 months (36.6 percent 5-year survival), respectively. Margin involvement was a significant predictor of cancer-specific (P<0.001) and overall survival (P<0.02).


CONCLUSIONS
Resection for recurrent rectal cancer results in good survival with acceptable morbidity, unaffected by the extent of resection. Extended radical resection to obtain clear resection margins is the appropriate management of locally recurrent rectal cancer.
Heriot
Alexander G
AG
Department of Surgical Oncology, Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, Victoria, Australia. alexander.heriot@petermac.org
Byrne
Christopher M
CM
Lee
Peter
P
Dobbs
Bruce
B
Tilney
Henry
H
Solomon
Michael J
MJ
Mackay
John
J
Frizelle
Frank
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome