title: Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence.
abstract: BACKGROUND
  Local re-recurrence after R0 resection of local recurrence of rectal cancer (LRRC) is not rare. The purpose of this study was to examine the pathological features of LRRC and determine the prognostic factors.
  
  
  METHODS
  Twenty-one patients underwent R0 resection of LRRC without preoperative therapy from 2000 to 2008. Tumor progression patterns were classified into three types: A, expanding type; B, infiltrating type; and C, intermediate type. Distant isolated cancer cells (DICCs) were defined as cancer cells present in isolation and at a distance (>1 mm) from the tumor edge.
  
  
  RESULTS
  Venous invasion was identified in all but one patient (95%). DICCs were observed in 11 of 21 cases. Type A patients had a significantly lower local re-recurrence rate (0/5) compared with type B and/or C patients (11/16, P = 0.012) and a significantly lower incidence of distant metastasis compared with type B and C patients (0/5 vs. 13/16, respectively; P = 0.0028). Multivariate regression analysis identified venous invasion of the primary lesion (P = 0.027) and tumor progression patterns (P = 0.039) as independent predictors of local re-recurrence.
  
  
  CONCLUSIONS
  The main features of LRRC were infiltrating growth, venous invasion, and DICCs. Tumor progression patterns correlated with local re-recurrence and distant metastasis. Preoperative adjuvant therapy to terminate peri-tumor cancer cells may be required for better tumor control.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Masataka
authors.initials: M
authors.lastname: Ikeda
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kitani
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Tokuoka
authors.forename: Ken
authors.initials: K
authors.lastname: Matsuda
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hata
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Ko
authors.initials: K
authors.lastname: Hosokawa
authors.forename: Nariaki
authors.initials: N
authors.lastname: Matsuura
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome