Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer.
BACKGROUND
The role of curative-intent surgery for retroperitoneal recurrence (RPR) of colorectal cancer (CRC) remains controversial. We previously showed 0% mortality and acceptable morbidity in patients who underwent resection of RPR.(1) Here we examine long-term overall and disease-free survival (OS, DFS).


METHODS
We identified patients who underwent resection for RPR of CRC between 01/1999 and 02/2010 from two prospective CRC databases.


RESULTS
The study cohort was composed of 48 patients (26 women) whose median age was 60 (36-80) years. Eleven patients had previously undergone resection of a different focus of disease recurrence, and 8 patients had additional site(s) of distant metastatic disease at the time of RPR resection. Following surgery for RPR, 5 patients were left with gross residual disease, and 6 had microscopically positive margins. Median follow-up was 32 (3-127) months. At last follow-up, 13 patients had died of cancer and 1 of other causes. For the entire cohort of 48 patients, 5-year OS was 70% (median 80 mo). In univariate analysis, OS was reduced in younger patients (p = 0.003) and in those with gross residual disease (p = 0.033). In patients who had grossly complete resection, 5-year DFS was 49% (median 38 mo). Predictors of reduced DFS on multivariable analysis were young age and R1 resection.


CONCLUSIONS
OS and DFS after resection of RPR in well-selected patients were favorable. Patients with RPR of CRC should be considered for curative-intent surgery with careful discussion at multidisciplinary cancer conference.
Division of Gastroenterology, Department of Medicine, University of Toronto, Ontario, Canada.
R
R
Razik
Department of Surgical Oncology, Princess Margaret and Mount Sinai Hospitals, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada. Electronic address: francis.zih@gmail.com.
F S W
FS
Zih
Division of General Surgery, University of Alberta, Edmonton, Alberta, Canada.
E
E
Haase
Department of Surgery, Memorial University, St. John's, Newfoundland, Canada.
A
A
Mathieson
Department of Surgical Oncology, Princess Margaret and Mount Sinai Hospitals, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
L
L
Sandhu
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
B
B
Cummings
Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
T
T
Lindsay
Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
A J
AJ
Smith
Department of Surgical Oncology, Princess Margaret and Mount Sinai Hospitals, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
C J
CJ
Swallow
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
Colorectal cancer; Nodal; Recurrence; Retroperitoneal