Abstract
Background: Although resection of locally recurrent rectal cancer has been associated with improved survival, clinical outcomes after such repeat surgery have been incompletely characterized.
Methods: From 1997 to 1999, 105 consecutive patients requiring repeat surgery for locally recurrent rectal cancer were identified. Patients were observed for a minimum of 2 years or until death.
Results: An operation was performed with palliative intent in 23% of patients. Before repeat surgery, 79% of the palliative-intent patients had symptoms: 21% bleeding, 42% obstruction, and 21% pain. After repeat surgery with palliative intent, improvement was noted in 40% with bleeding, 70% with obstruction, and 20% with pain. Additional or recurrent symptoms were noted in 87% during follow-up. Seventy-seven percent of patients had an operation with nonpalliative intent. Before repeat surgery, 57% of nonpalliative patients had symptoms, with 32% experiencing bleeding, 11% obstruction, and 19% pain. After repeat surgery with nonpalliative intent, initial improvement was noted in 88% with bleeding, 78% with obstruction, and 40% with pain. During follow-up, symptoms arose in 37% of the initially asymptomatic patients, and additional or recurrent symptoms were seen in 63% of those previously symptomatic.
Conclusions: Although symptomatic relief is associated with repeat surgery, the recurrence or development of alternate symptoms makes a completely asymptomatic clinical course uncommon.
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REFERENCES
Salo JC, Paty PB, Guillem J, et al. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol 1999; 6: 171–7.
Secco GB, Fardelli R, Rovida S, et al. Is intensive follow-up really able to improve prognosis of patients with local recurrence after curative surgery for rectal cancer? Ann Surg Oncol 2000; 7: 32–7.
Pilisphen SJ, Heilweil M, Quan SH, et al. Patterns of pelvic recurrence following definitive resection of rectal cancer. Cancer 1984; 53: 1354–62.
Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988; 80: 21–9.
Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project protocol R-02. J Natl Cancer Inst 2000; 92: 388–96.
Camilleri-Brennan J, Stele RJC. The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol 2001; 27: 349–53.
Sasson AR, Sigurdson ER. Management of locally advanced rectal cancer. Surg Oncol 2000; 9: 193–204.
Beart RW. New success with management of recurrent rectal cancer—a reason to follow patients. Ann Surg Oncol 1999; 6: 131–2.
Weoch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg 1978; 135: 505–11.
Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following‘curative surgery‘ for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974; 34: 1278–92.
Rao AR, Kagan AR, Chan PM, et al. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981; 48: 1492–5.
Rich T, Gunderson LL, Lew R, et al. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983; 52: 1317–29.
Schiesel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg 1986; 73: 342–52.
Wannebo HJ, Gaker DL, Whitehill R, et al. Pelvic recurrence of rectal cancer. Options for curative resection. Ann Surg 1987; 205: 482–95.
Suzuki K, Dozois RR, Devine RM, et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum 1996; 39: 730–6.
Fazio VW, Harris JC. Decision-making. What tests to do? What choices to consider? Surg Clin North Am 2000; 9: 839–49.
Miner TJ, Jaques DP, Tavaf-Motamen H, Shriver CD. Decision making on surgical palliation based on patient outcome data. Am J Surg 1999; 177: 150–4.
Miner TJ, Jaques DP, Shriver CD. A prospective evaluation of patients undergoing surgery for the palliation of an advanced malignancy. Ann Surg Oncol 2002; 9: 696–703.
Porzsolt F, Tannock I. Goals of palliative cancer therapy. J Clin Oncol 1993; 11: 378–81.
Martin RC, Jaques DP, Brennan MF, Karpeh M. Achieving R0 resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg 2002; 194: 568–77.
Bropphy PF, Hoffman JP, Eisenberg BL. The role of palliative pelvic exenteration. Am J Surg 1994; 167: 386–90.
Yeung RS, Moffat FL, Falk RE. Pelvic exenteration of recurrent and extensive primary colorectal adenocarcinoma. Cancer 1993; 72: 1853–8.
Deckers PJ, Olsson C, Williams LA, Mozden PJ. Pelvic exenteration as palliation of malignant disease. Am J Surg 1976; 131: 509–15.
AB Ball, M Baum, NM Breach. Surgical palliation. In: Derek D, Hanks GWC, MacDonald N eds. Oxford Textbook of Palliative Medicine. Oxford, UK: Oxford Press, 1998: 282 97.
Forbes JF. Palliative surgery in cancer patients: principles and potential of palliative surgery in patients with advanced cancer. Recent Results Cancer Res 1988; 108: 134–42.
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Miner, T.J., Jaques, D.P., Paty, P.B. et al. Symptom Control in Patients With Locally Recurrent Rectal Cancer. Ann Surg Oncol 10, 72–79 (2003). https://doi.org/10.1245/ASO.2003.03.040
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DOI: https://doi.org/10.1245/ASO.2003.03.040