title: Local recurrence of rectal cancer: a population-based cohort study of diagnosis, treatment and outcome.
abstract: OBJECTIVE
  Local recurrence is an important endpoint of rectal cancer treatment, but details of this form of treatment failure are less well described. The aim of this study was to acquire deeper knowledge of local recurrence regarding symptoms, diagnostic work-up, clinical management, health-care utilization and outcome.
  
  
  METHODS
  Of 671 patients with rectal cancer, 57 were diagnosed with local recurrence within 5 years after surgery. Their records were analysed.
  
  
  RESULTS
  At diagnosis of local recurrence 49 (86%) of 57 patients were symptomatic and 40 (70%) were diagnosed between scheduled follow-up visits. The predominant symptom was pain. Forty-five of the 57 (79%) had a palpable tumour. Most were deemed incurable at presentation and 10 (18%) were operated on with curative intent. Five years after the initial rectal cancer surgery, two patients were alive, with one free of disease. Despite the need for multiple interventions, including surgery, only four out of 40 patients were classified as being well-palliated in the terminal stage.
  
  
  CONCLUSIONS
  Follow-up after rectal cancer surgery by annual clinical examination is not sufficient to detect local recurrence when it is asymptomatic. Local recurrence of rectal cancer is often associated with intractable symptoms. These patients require frequent interventions and can rarely be cured if diagnosed at an advanced stage. Strategies for early detection of local recurrence and the management thereof require improvement.
authors: Sahlgrenska Academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. karl.kodeda@vgregion.se
authors: K
authors: K
authors: Kodeda
authors: K
authors: K
authors: Derwinger
authors: B
authors: B
authors: Gustavsson
authors: S
authors: S
authors: Nordgren
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D010146:Pain / Q000209:etiology; D010166:Palliative Care; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome