title: Is curative resection and long-term survival possible for locally re-recurrent colorectal cancer in the pelvis?
abstract: BACKGROUND
  A multimodality approach for locally recurrent colorectal cancer in the pelvis provides a significant survival advantage when negative margins are achieved. However, outcomes of surgical resection in patients who have locally re-recurrent disease in the pelvis are not well studied. Our aim was to assess the safety, feasibility of a negative margin resection, and survival outcomes in patients with pelvic locally re-recurrent colorectal cancer.
  
  
  METHODS
  A retrospective review identified 406 patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. Patients who had locally re-recurrent disease in the pelvis who underwent curative-intent resection were identified.
  
  
  RESULTS
  Forty-seven patients (31 male) were identified. Median age was 57 years (range, 30-84 years). Median time to re-recurrence was 2.4 years (range, 0.5-5.6 years). Margin status following re-resection was R0 60%, R1 32%, and R2 8%. Nonbowel organs were resected en bloc in 81%, including 7 sacral resections. Intraoperative radiation was given to 77%. Morbidity occurred in 42%, with 6% requiring reoperation for complications. Thirty-day mortality was nil. Overall survival at 2 and 5 years was 83% and 33%. Disease-free survival at 2 and 5 years was 55% and 27%. Five-year survival for patients who had R0 and R1 resections was 37% and 42%, whereas no patients having an R2 resection survived beyond 2 years (p = 0.002).
  
  
  CONCLUSIONS
  In highly selected patients with re-recurrent colorectal cancer in the pelvis, we found that surgery could be performed safely and that a curative (R0) resection was possible in more than 50%. Two- and 5-year survival rates are comparable to results seen when surgery is done for first-time recurrences.
authors.affiliation: Department of Surgery, Division of General Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Dorin T
authors.initials: DT
authors.lastname: Colibaseanu
authors.forename: Kellie L
authors.initials: KL
authors.lastname: Mathis
authors.forename: Zaid M
authors.initials: ZM
authors.lastname: Abdelsattar
authors.forename: Zaid M
authors.initials: ZM
authors.lastname: Abdelsatter
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009364:Neoplasm Recurrence, Local; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D010388:Pelvis / Q000473:pathology / Q000601:surgery*; D011878:Radiotherapy / Q000379:methods; D012086:Reoperation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D017741:Survivors