title: Surgical strategy for local recurrence after resection of rectal cancer.
abstract: OBJECTIVE
  To evaluate surgery for local recurrence after rectal cancer resection.
  
  
  METHODS
  In total, 76 patients with local recurrence after rectal cancer resection were enrolled between 1978 and 1998. Of these, 61 underwent curative resection. Outcomes were assessed according to treatment. Recurrence was classified as visceral or parietal based on preoperative computed tomography or magnetic resonance imaging.
  
  
  RESULTS
  The 5-year survival rates were 17.8%, 25.9%, and 36.9% for patients who underwent total pelvic exenteration, abdomino-perineal resection, and local resection, respectively. Of the 61 patients who underwent curative resection, 18 (29.5%) showed visceral recurrence and 43 (70.5%) showed parietal recurrence. Among patients with visceral recurrence, 9 (50%) underwent total pelvic exenteration, 6 (33.3%) underwent abdomino-perineal resection, and 3 (16.7%) underwent local resection. Among patients with parietal recurrence, 27 (62.8%) underwent total pelvic exenteration, 4 (9.3%) underwent abdomino-perineal resection, and 12 (27.9%) underwent local resection. Mucinous adenocarcinomas were most common among patients with parietal recurrence. Overall 5-year survival rates were 64.9% and 14.0% for patients with visceral and parietal recurrence, respectively.
  
  
  CONCLUSIONS
  Curative resection was effective in rectal cancer patients with visceral recurrence. Novel systemic chemical radiotherapy should be considered for patients with parietal recurrence.
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan. u0970047@urahp.yokohama-cu.ac.jp
authors.forename: Shoichi
authors.initials: S
authors.lastname: Fujii
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yamagishi
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ota
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ike
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ohki
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010385:Pelvic Exenteration; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate