title: Outcome of surgical resection of second-time locally recurrent rectal cancer.
abstract: BACKGROUND
  Locally recurrent rectal cancer relapses in the pelvis in up to 60 per cent of patients following resection. This study assessed the surgical and oncological outcomes of patients who underwent surgery for re-recurrent rectal cancer.
  
  
  METHODS
  Patients who underwent second-time resection of locally recurrent rectal cancer between 2001 and 2010 were eligible for inclusion. Data were collected on demographics, presentation of disease, preoperative staging imaging, adjuvant therapy, operative detail, histopathology and follow-up status (clinical and imaging) for the primary tumour, and first and second recurrences.
  
  
  RESULTS
  Thirty patients (of 56 discussed at the multidisciplinary meeting) underwent resection of re-recurrent rectal cancer. Postoperative morbidity occurred in nine patients but none died within 30 days. Negative resection margins (R0) were achieved in ten patients, microscopic margin positivity (R1) was evident in 15 and macroscopic involvement (R2) was found in five. Although no patient had distant metastatic disease, 22 had involvement of the pelvic side wall. One- and 3-year overall survival rates were 77 and 27 per cent respectively, with a median overall survival of 23 (range 3-78) months. An R0 resection conferred a survival benefit (median survival 32 (11-78) months versus 19 (6-33) months after R1 and 7 (3-10) months after R2 resection).
  
  
  CONCLUSIONS
  Surgical resection of re-recurrent rectal cancer had comparable surgical and oncological outcomes to initial recurrences in well selected patients.
authors.affiliation: John Goligher Department of Colorectal Surgery, St James's University Hospital, Beckett Street, Leeds LS7 7TF, UK.
authors.forename: D P
authors.initials: DP
authors.lastname: Harji
authors.forename: P M
authors.initials: PM
authors.lastname: Sagar
authors.forename: K
authors.initials: K
authors.lastname: Boyle
authors.forename: S
authors.initials: S
authors.lastname: Maslekar
authors.forename: B
authors.initials: B
authors.lastname: Griffiths
authors.forename: D R
authors.initials: DR
authors.lastname: McArthur
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome