title: Long-term surveillance of locally advanced rectal cancer patients with neoadjuvant chemoradiation and aggressive surgical treatment of recurrent disease: a consecutive single-centre experience.
abstract: OBJECTIVE
  The aim of this study was to analyse the long-term outcome of rectal cancer patients who submitted to preoperative chemoradiation with consecutive intensive follow-up and aggressive surgical treatment of recurrent disease.
  
  
  METHODS
  Patients with locally advanced (cT3-4 Nx M0-1) mid/low rectal cancer were treated at a tertiary university hospital with preoperative long-course chemoradiation followed by resection (according to a prospective study protocol). After resection, all patients were urged to participate in a standardised, risk-independent intensive follow-up program. All curatively treated patients (n = 153, 96 %) were included in our long-term analysis with respect to curative re-resection of recurrent disease.
  
  
  RESULTS
  Of 153 patients, 143 (93 %) participated in our follow-up program: 63 % were surveyed longer than 5 years after primary therapy (mean follow-up 75 months, 95 % CI 67.8-82.2). Fifty-five (36 %) patients developed cancer recurrence (mean 27.8 months, 95 % CI 20.6-34.9, range 3-108), giving a disease-free survival rate of 68.5 and 60.7 % at 5 and 10 years; 21 (38 %) patients were re-resected curatively and 58 (38 %) patients died during the observation period, giving an overall survival rate of 70.8 and 57.5 % at 5 and 10 years. Multivariate analysis found tumour differentiation (P < 0.01), operative procedure (P < 0.05) and downstaging (P < 0.01) to be independent variables influencing overall survival.
  
  
  CONCLUSIONS
  The combination of multimodal therapy and aggressive surgical treatment of metastases including repeated re-resections in curative intention is relevant in order to chronify the disease. Thus, both intensive and extended follow-up beyond 5 years appear to be mandatory.
authors: Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria. matthias.zitt@i-med.ac.at.
authors: Matthias
authors: M
authors: Zitt
authors: Department of Radiotherapy-Radiooncology, Innsbruck Medical University, Innsbruck, Austria.|Department of Radiooncology, Feldkirch Hospital, Feldkirch, Austria.
authors: Alexander
authors: A
authors: DeVries
authors: Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.|Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria.
authors: Josef
authors: J
authors: Thaler
authors: Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.
authors: Reinhold
authors: R
authors: Kafka-Ritsch
authors: Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.
authors: Wolfgang
authors: W
authors: Eisterer
authors: Department of Radiotherapy-Radiooncology, Innsbruck Medical University, Innsbruck, Austria.
authors: Peter
authors: P
authors: Lukas
authors: Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria.
authors: Dietmar
authors: D
authors: Öfner
mesh_terms: D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Aggressive surgical therapy of recurrence; Preoperative chemoradiation; Rectal cancer