Prediction of residual disease or distant metastasis after resection of locally recurrent rectal cancer.
OBJECTIVE
It is important to preoperatively identify patients at high risk of relapse at extrapelvic sites or residual disease after salvage surgery for locally recurrent rectal cancer to maximize the survival benefit by indicating whether a surgical approach might be successful.


METHODS
Data from 101 consecutive patients who underwent exploration with curative intent for local recurrence after radical resection of rectal cancer were retrospectively collected. Preoperative factors were examined in univariate and multivariate analyses for their ability to predict resectability and distant disease-free survival.


RESULTS
The 5-year disease-specific survival rates of R0, R1, and R2 resection were 43.3%, 19.5%, and 10.0%, respectively (P < .001). In a logistic regression analysis, upper sacral (above the inferior margin of the second sacrum)/lateral invasive type and high-grade lymphatic invasion of the primary tumor were associated with palliative surgery. A Cox regression analysis revealed that upper sacral/lateral invasive type, extrapelvic disease, hydronephrosis at recurrence, and high-grade lymphatic or venous invasion of the primary tumor were associated with a lower distant disease-free survival rate. Patients with one or more of these risk factors had a 3-year distant disease-free survival rate of 6.2% compared with 54.1% for those with none of these risk factors.


CONCLUSIONS
It was possible to preoperatively identify patients at high risk of relapse or residual disease. This system might be used on an individual basis to select patients with locally recurrent rectal cancer for chemotherapy or radiotherapy before surgical intervention with curative intent.
Kanemitsu
Yukihide
Y
Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. ykanemit@aichi-cc.jp
Hirai
Takashi
T
Komori
Koji
K
Kato
Tomoyuki
T
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate