title: The Outcomes and Patterns of Treatment Failure After Surgery for Locally Recurrent Rectal Cancer.
abstract: OBJECTIVE
  To assess the outcomes and patterns of treatment failure of patients who underwent pelvic exenteration surgery for recurrent rectal cancer.
  
  
  BACKGROUND
  Despite advances in the management of rectal cancer, local recurrence still occurs. For appropriately selected patients, pelvic exenteration surgery can achieve long-term disease control.
  
  
  METHODS
  Prospectively maintained databases of 5 high volume institutions for pelvic exenteration surgery were reviewed and data combined. We assessed the combined endpoints of overall 5-year survival, cancer-specific 5-year mortality, local recurrence, and the development of metastatic disease.
  
  
  RESULTS
  Five hundred thirty-three patients who had undergone surgery for locally recurrent rectal cancer were identified. Five-year cancer-specific survival for patients with a complete (R0) resection is 44%, which was achieved in 59% of patients. For those with R1 and R2 resections, the 5-year survival was 26% and 10%, respectively. Radical resection required sacrectomy in 170 patients (32%), and total cystectomy in 105 patients (20%). Treatment failure included local recurrence alone in 75 patients (14%) and systemic metastases with or without local recurrence in 226 patients (42%). Chemoradiotherapy before exenteration was associated with a significant (P < 0.05) improvement in overall 5-year cancer-specific survival for those patients with an R0 resection. Postoperative chemotherapy did not alter outcomes.
  
  
  CONCLUSIONS
  R0 resection of the pelvic recurrence is the most significant factor affecting overall and disease-free survival. The surgery is complex and often highly morbid, and where possible patients should be given perioperative chemoradiotherapy. Further investigations are required to determine the role of adjuvant chemotherapy.
authors.affiliation: *Christchurch Hospital, Christchurch, New Zealand†Royal Prince Alfred Hospital, Sydney, Australia‡Peter MacCallum Cancer Centre, Melbourne, Australia§St James Hospital, Leeds, UK¶The Royal Marsden Hospital, London, UK.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Harris
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Solomon
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Heriot
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sagar
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
authors.forename: Liane
authors.initials: L
authors.lastname: Dixon
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pascoe
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Dobbs
authors.forename: Chris M
authors.initials: CM
authors.lastname: Frampton
authors.forename: Deena P
authors.initials: DP
authors.lastname: Harji
authors.forename: Christos
authors.initials: C
authors.lastname: Kontovounisios
authors.forename: Kirk K
authors.initials: KK
authors.lastname: Austin
authors.forename: Cherry E
authors.initials: CE
authors.lastname: Koh
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lee
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Lynch
authors.forename: Satish K
authors.initials: SK
authors.lastname: Warrier
authors.forename: Frank A
authors.initials: FA
authors.lastname: Frizelle
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010385:Pelvic Exenteration; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure