Radicality of resection and survival after multimodality treatment is influenced by subsite of locally recurrent rectal cancer.
OBJECTIVE
To analyze results of multimodality treatment in relation to subsite of locally recurrent rectal cancer (LRRC).


METHODS
A total of 170 patients with LRRC who underwent treatment between 1994 and 2008 were studied. The basic principle of multimodality treatment was preoperative (chemo)radiotherapy, intended radical surgery, and intraoperative radiotherapy. The subsites of LRRC were classified as presacral, posterolateral, (antero)lateral, anterior, anastomotic, or perineal. Subsites were related to radicality of the resection, local re-recurrence rate, distant metastasis rate, and cancer-specific survival.


RESULTS
R0 resections were achieved in 54% of the patients, and 5-year cancer-specific survival was 40.5%. The worst outcomes were seen in presacral LRRC, with only 28% complete resections and 19% 5-year survival (p = 0.03 vs. other subsites). Anastomotic LRRC resulted in the most favorable outcomes, with 77% R0 resections and 60% 5-year survival (p = 0.04). Generally, if a complete resection was achieved, survival improved, except in posterolateral LRRC. Local re-recurrence and metastasis rate were lowest in anastomotic LRRC.


CONCLUSIONS
Classification of the subsite of LRRC is a predictor of potentially resectable and consequently curable disease. Treatment of posterior LRRC imposes poor results, whereas anastomotic LRRC location shows superior results.
Kusters
Miranda
M
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Dresen
Raphaëla C
RC
Martijn
Hendrik
H
Nieuwenhuijzen
Grard A
GA
van de Velde
Cornelis J H
CJ
van den Berg
Hetty A
HA
Beets-Tan
Regina G H
RG
Rutten
Harm J T
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009426:Netherlands; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D015996:Survival Rate