title: Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment.
abstract: OBJECTIVE
  To investigate the patterns and decisive prognostic factors for local recurrence of rectal cancer treated with a multidisciplinary team (MDT) modality.
  
  
  METHODS
  Ninety patients with local recurrence were studied, out of 1079 consecutive rectal cancer patients who underwent curative surgery from 1999 to 2007. For each patient, the recurrence pattern was assessed by specialist radiologists from the MDT using imaging, and the treatment strategy was decided after discussion by the MDT. The associations between clinicopathological factors and long-term outcomes were evaluated using both univariate and multivariate analysis.
  
  
  RESULTS
  The recurrence pattern was classified as follows: Twenty-seven (30%) recurrent tumors were evaluated as axial type, 21 (23.3%) were anterior type, 8 (8.9%) were posterior type, and 13 (25.6%) were lateral type. Forty-one patients had tumors that were evaluated as resectable by the MDT and ultimately received surgery, and R0 resection was achieved in 36 (87.8%) of these patients. The recurrence pattern was closely associated with resectability and R0 resection rate (P < 0.001). The recurrence pattern, interval to recurrence, and R0 resection were significantly associated with 5-year survival rate in univariate analysis. Multivariate analysis showed that the R0 resection was the unique independent factor affecting long-term survival.
  
  
  CONCLUSIONS
  The MDT modality improves patient selection for surgery by enabling accurate classification of the recurrence pattern; R0 resection is the most significant factor affecting long-term survival.
authors: Department of Colorectal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors: Jun
authors: J
authors: Zhao
authors: Chang-Zheng
authors: CZ
authors: Du
authors: Ying-Shi
authors: YS
authors: Sun
authors: Jin
authors: J
authors: Gu
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D010166:Palliative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome
keywords: Local recurrence; Prognosis; Rectal cancer; Surgery; Survival