Patterns of Local Recurrence in Rectal Cancer: A Single-Center Experience

A cohort of patients operated at the National Cancer Center Hospital in Tokyo for rectal carcinoma, at or below the peritoneal reflection, was reviewed retrospectively. The purpose was to study the risk factors for local relapse and the patterns of local recurrence. Three hundred fifty-one patients operated between 1993 and 2002 for rectal carcinoma, at or below the peritoneal reflection, were analyzed. One hundred forty-five patients, with preoperatively staged T1 or T2 tumors without suspected lymph nodes, underwent total mesorectal excision (TME). Lateral lymph node dissection (LLND) was performed in suspected T3 or T4 disease, or when positive lymph nodes were seen; 73 patients received unilateral LLND and 133 patients received bilateral LLND. Of the 351 patients 6.6% developed local recurrence after 5 years. TME only resulted in 0.8% 5-year local recurrence. In lymph-node-positive patients, 33% of the unilateral LLND group had local relapse, significantly more (p = 0.04) than in the bilateral LLND group with 14% local recurrence. Local recurrence in the lateral, presacral, perineal, and anastomotic subsites was lower in the bilateral LLND group as compared with in the unilateral LLND group. We conclude that, in selected patients, surgery without LLND has a very low local recurrence rate. Bilateral LLND is more effective in reducing the chance of local recurrence than unilateral LLND. Either surgical approach, with or without LLND, requires reliable imaging during work-up. An erratum to this article is available at .     

Radical Redo Surgery for Local Rectal Cancer Recurrence Improves Overall Survival: A Single Center Experience

Background  To date, the survival benefit of redo surgery in locally recurrent rectal adenocarcinoma remains unclear. Study Design  In an institutional study, operations for recurrence were retrospectively analyzed. Survival was calculated using the Kaplan–Meier plot and Cox regression analysis. Results  A total of 72 patients with local recurrence were explored or resected. In 38 patients, there was synchronous distant organ recurrence. Forty-five of 72 were re-resected and in 37 of 45 cases, R0 situations were achieved. In 11 of 38 metastasized patients, both local and distant organ recurrence were successfully removed. For obtaining tumor control, resections of inner genitals, bladder, and sacral bone were necessary in 10, 4, and 11 patients, respectively. Survival was better for patients re-resected with a median overall survival of 54.9 months, as compared with 31.1 months among non-resected patients (p = 0.0047, log-rank test). Subgroup analysis revealed that a benefit of re-resection was observed to a lesser extent in synchronous local and in distant disease. Cox analysis showed that initial Dukes stage and complete resections of local recurrences were independently determining prognosis (relative risk 1.762 and 0.689, p = 0.008 and p = 0.002, respectively). Conclusions  Radical surgery for local recurrence can improve survival if complete tumor clearance is achieved, and concomitant distant tumor load should not principally preclude re-resection.     

Resection of Local Recurrence of Rectal Cancer: Results

Locally recurrent rectal cancer is a difficult clinical problem, and surgical resection can be done only in selected patients. The aims of this study were to evaluate the results of resecting the local recurrence of rectal cancer and to analyze factors that might predict curative re-resection and those that affect survival. Forty-seven patients who underwent resection for locally recurrent rectal cancer formed the basis of the study. Twenty-four were curative in nature, and the others were palliative. There was no operative mortality, and the complication rate was 38%. The median survival of the whole group was 16.5 months. The ability to perform curative resection was found to be the only independent factor associated with improved survival. Female gender is a significant factor associated with curative resection of local recurrence. In patients with curative reresection, local control is up to 87%. It was concluded that resection of local recurrent rectal cancer can achieve good local control and can improve survival in selected patients. The ability to perform curative resection is associated with survival benefit, and female gender is associated with the increased possibility of carrying out curative resection.     

直肠癌局部复发的综合治疗

直肠癌术后局部复发通常指直肠癌根治性切除术后盆腔内的复发,包括吻合口、直肠周围间隙、会阴部切口和盆腔内淋巴结的复发,可分为单纯的盆腔内局部复发和伴有盆腔以外其他脏器转移的局部复发两种情况。随着对盆腔解剖认识的不断深入,全直肠系膜切除术、术前和术后辅助治疗的广泛应用,直肠癌治疗的总体水平得到明显提高,保肛率明显上升,术后长期生存率明显提高。近10年来,直肠癌术后局部复发率已从2.6%～32%降低至6％～10％。     

The Effect of Intraoperative Rectal Washout on Local Recurrence after Rectal Cancer Surgery: A Meta-Analysis

Background

Implantation of exfoliated cancer cells has been suggested as a possible mechanism of local recurrence at the site of colorectal anastomosis. Intraoperative rectal washout has been suggested to eliminate free cancer cells; however, there is no conclusive evidence of a beneficial effect of intraoperative rectal washout on local recurrence after anterior resection of rectal cancer.

Methods

Studies published through February 2012 evaluating the impact of intraoperative rectal washout for local recurrence or positive cytology from donuts wash were identified by an electronic literature search. A meta-analysis was performed using the DerSimonian-Laird random-effects models to compute risk ratio (RR) along with 95 % confidence intervals (CI).

Results

Nine studies met the inclusion criteria, yielding a total of 5,395 patients. Eight studies evaluated overall local recurrence, including anastomotic recurrence, and five of the eight studies evaluated anastomotic recurrence separately. Two studies evaluated positive cytology from donuts wash. Local recurrence rate was 5.79 % in the washout group and 10.05 % in the no washout group—a difference that was statistically significant (RR = 0.57; 95 % CI = 0.46-0.71; P < 0.00001). Rectal washout significantly reduced the risk of anastomotic recurrence (RR = 0.3; 95 % CI = 0.12-0.71; P = 0.007). No influence of rectal washout was observed on positive cytology from donuts wash.

Conclusions

From the results of this meta-analysis, it may be justified to recommend intraoperative rectal washout to prevent local recurrence in rectal cancer surgery.     

直肠癌前切除低位吻合术后局部复发39例原因分析

直肠癌前切除低位吻合(Dixon'soperation)术后局部复发一般是指盆腔淋巴结复发、吻合口复发、周围脏器浸润及手术范围内局部复发,是直肠癌治疗失败的主要原因。文献报道根治术后复发率平均为30%左右,在DukesB期和DukesC期的直肠癌根治术后局部复发率分别是25%和50%[1]。为探讨直肠癌Dixon术后局部复发的原因,寻找对策,本文回顾性分析我院1988～1999年收治的332例直肠癌行Dixon术病人的临床资料,其中局部复发者为39例,分析报道如下。临床资料1.一般资料本组共39例,男21例,女18例。年龄25～70岁,中位年龄51岁。病理类型:腺癌23例,黏液腺癌9…     

直肠癌局部复发的治疗现状

结直肠癌是目前世界上第3位常见的恶性肿瘤,2008年全球有超过120万人患此疾病,约60万人死于该疾病;我国结直肠癌的发病率已超过世界平均水平,男女发病率分别为21／10万和14／10万。与欧美国家不同,我国的大肠癌以直肠癌为主,占总数的一半以上,严重威胁到人民的健康,是我国面临的重要的健康问题。由于盆腔的解剖结构复杂、空间狭小,因此直肠癌手术对外科医生有着很高的技巧要求。     

直肠癌前切除术后局部复发的综合治疗进展

目的 探讨直肠癌前切除术后局部复发癌的外科综合治疗方法.方法 收集近年来国内、外有关直肠癌局部复发外科综合治疗进展的文献并作一综述.结果 积极有效的外科手术结合放、化疗是提高患者生存率的主要途径.结论 对于直肠癌前切除术后局部复发癌应采用个体化的外科综合治疗方案,以延长患者的生存时间,改善症状,提高生存质量.     

Effect of Adjuvant Radiotherapy on Local Recurrence in Stage II Rectal Cancer

Background Prospective trials have demonstrated that chemotherapy combined with radiotherapy decreases local recurrence rates in stage II and stage III rectal cancer. Some patients with stage II lesions, however, have relatively low risks of local recurrence. We evaluated the effect of radiotherapy on local recurrence in patients with stage IIA rectal cancer. Methods From the colorectal cancer database, we identified 390 stage IIA rectal cancer patients who underwent curative resection followed by adjuvant therapy from 1995 to 2002; a total of 72 patients who received preoperative chemoradiotherapy and who did not receive adjuvant therapy were excluded. Mean follow-up period was 65 months (range, 2–133 months). Results Of the 390 patients, 110 had primary tumors in the upper rectum, 136 in the midrectum, and 144 in the lower rectum. Lymphovascular invasion was observed in 35 patients (9.0%). Mean (± SD) number of examined lymph nodes was 18 (± 12). Adjuvant chemotherapy was provided to 180 patients (46.2%), and chemotherapy plus radiotherapy was provided to 210 patients (53.8%). Radiotherapy was significantly more common in younger patients (P = .01) and those with lower rectal cancer (P < .001). Local recurrence rate did not differ between patients who did and did not receive radiotherapy. In patients with mid and lower rectal cancer, the local recurrence rate was not affected by radiotherapy. Conclusions Radiotherapy did not seem to provide additional benefit in decreasing local recurrence rate of stage IIA rectal cancers. In selected patients, however, the role of radiotherapy needs to be carefully evaluated.     

直肠癌术后局部复发转移的临床病理因素分析

目的探讨可能导致直肠癌术后局部复发的临床病理因素。方法应用单因素和多因素分析方法,回顾性分析2004年1月至2011年4月期间我院收治的368例直肠癌患者完整临床及病理资料。结果局部复发73例,占同期直肠癌(368例)的19.84%。单因素分析结果显示,直肠癌患者的性别、肿瘤距肛缘距离、肿瘤周径、TNM分期、组织学类型、脉管浸润、肿瘤穿孔、吻合口漏及放化疗与术后局部复发有关(P<0.05),而与年龄、病程、大体类型、肿瘤直径及手术方式无关(P>0.05)。进一步多因素分析结果显示,肿瘤距肛缘距离、肿瘤周径、TNM分期、组织学类型、脉管浸润、肿瘤穿孔及放化疗是术后局部复发转移的危险因素(P<0.05)。结论直肠癌术后局部复发与多种因素有关,脉管浸润是最重要的危险因素。     

直肠癌前切除术后局部复发的防治

目的：探讨直肠癌前切除术后局部复发的防治。方法：回顾性分析46例直肠癌前切除术后局部复发再手术患的临床特点、治疗方法及防治措施。结果：再次手术证实局部复发的病例中，吻合口复发7例，吻合口周围组织局部复发15例，直肠系膜复发24例，予手术切除27例，余19例无法切除。结论：局部复发与首次手术时未严格遵循无瘤操作原则、淋巴清扫不彻底、肠管切除不足、全直肠系膜切除不够等有关。把握好第一次手术术式的彻底性、完整性是防止局部复发的关键。     

直肠癌局部复发的多学科综合诊治进展

l概述结直肠癌是我国最常见的消化道恶性肿瘤之一。据2012年《中国肿瘤登记年报》…数据显示,结直肠癌发病率位列所有恶性肿瘤的第3位,而死亡率则为第5位。这些数据表明,结直肠癌对我国人民的健康构成了很大的威胁。     

Chronological Improvement in Survival Following Rectal Cancer Surgery: A Large-Scale, Single-Center Study

Background

Total mesorectal excision (TME) and preoperative chemoradiation therapy (PCRT) for rectal cancer are used sequentially in our center. The aim of this study was to evaluate survival of patients with stage II/III rectal cancer chronologically and to determine whether therapeutic advances associated with TME and PCRT have improved patient survival.

Methods

A retrospective review of 2,197 patients from July 1989 to December 2006 was conducted. The time period (P) for this study was divided into three groups: P1 (1989–1995), P2 (1996–2001) for TME, P3 (2002–2006) for PCRT. Cancer-specific survival (CSS), disease-free survival (DFS), and recurrences among the three periods were investigated.

Results

A total of 293 patients in P1, 836 patients in P2, and 1,068 patients in P3 were enrolled. The 5-year CSS in stages II and III was statistically different between P1/P2 and P3 (stage II, p = 0.008; stage III, p < 0.001). The 5-year DFS was significantly different between P1/P2 and P3 for stage III (p = 0.001). The local recurrence and systemic recurrence rates decreased during P3, but there was no significant difference between the three periods for stage II. For stage III, local recurrence was significantly different between the three periods (P1 vs. P2, p = 0.002; P1 vs. P3, p < 0.001; P2 vs. P3, p = 0.008).

Conclusions

We identified an improvement in survival for stage II/III rectal cancer and a decrease in local recurrence for stage III rectal cancer during P3, the most recent period. This may be due to frequent application of PCRT based on the TME.     

Pathologic Complete Response After Neoadjuvant Treatment for Rectal Cancer Decreases Distant Recurrence and Could Eradicate Local Recurrence

Background

The aim of this study was to evaluate the clinical implications of pathologic complete response (pCR) (i.e., T0N0M0) after neoadjuvant chemoradiation and radical surgery in patients with locally advanced rectal cancer.

Materials and Methods

A single-center, prospectively maintained colorectal cancer database was queried for patients with primary cII and cIII rectal cancer staged by CT and ERUS/MRI undergoing long-course neoadjuvant chemoradiation followed by proctectomy with curative intent between 1997 and 2007. Patients were stratified into pCR and no-pCR groups and compared with respect to demographics, tumor and treatment characteristics, and oncologic outcomes. Outcomes evaluated were 5-year overall survival, disease-free survival, disease-specific mortality, local recurrence, and distant recurrence.

Results

The query returned 238 patients (73% male), with a median age of 57 years and median follow-up of 54 months. Of these, 58 patients achieved pCR. Patients with pCR vs no-pCR were statistically comparable with respect to demographics, chemoradiation regimens, tumor distance from anal verge, clinical stage, surgical procedures performed, and follow-up time. No patient with pCR had local recurrence. Overall survival and distant recurrence were also significantly improved for patients achieving pCR.

Conclusions

Achievement of pCR after neoadjuvant chemoradiation is associated with greatly improved cancer outcomes in locally advanced rectal cancer. Future studies should evaluate the relationship between increases in pCR rates and improvements in cancer outcomes in this population.     

直肠癌局部复发的治疗现状及放射治疗进展

结直肠癌是常见的消化道恶性肿瘤。在美国,结直肠癌居恶性肿瘤死亡率第3位。近年来,随着我国经济快速发展,生活方式及饮食结构不断改变,结直肠癌发病率逐年上升,目前也已成为第3位常见恶性肿瘤。我国结直肠癌流行病学特征之一是直肠癌发病率高,且低位直肠癌比例高。近期研究提示,目前结直肠癌发病有右移趋势,但直肠癌所占比例仍高达49．7％～65．8％。目前,手术治疗是直肠癌患者的主要治疗手段,但由于其特殊的解剖结构,直肠癌根治术后发生局部复发和远处转移的几率仍较高。     

直肠癌局部复发行全盆腔脏器切除术的临床意义及适应证选择

随着全直肠系膜切除术（TME）及新辅助治疗的普遍应用,近10年来直肠癌的局部复发率已经从20％～40％降低至4％～8％。直肠癌局部复发（LRRc）治疗方式的选择是临床决策的难点。据统计,大约50％的局部复发患者不伴有远处脏器转移,而最理想的治疗方法是将复发肿瘤完整切除（R0切除）。目前的手术方式包括腹会阴联合切除术（APR）、低位前切除术（LAR）、全盆腔脏器切除术（TPE）、后盆腔脏器切除术（PPE）等,其中TPE的R0切除率可达30％～40％,是目前治疗LRRC的主要术式。