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Analysis of local recurrence rates after surgery alone for rectal cancer

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Abstract

Local recurrence (LR) continues to be a major problem following surgical treatment for rectal cancer, and proposed ways of reducing this remain controversial. The aim of this study was to review results from published surgical series in which adjuvant therapies were not used. A Medline search identified series published between January 1982 and December 1992 with follow-up on at least 50 patients with rectal cancer treated surgically for cure, without adjuvant therapy. Fifty one papers reported follow-up on 10,465 patients with a median LR rate of 18.5%. LR was 8.5%, 16.3% and 28.6% in Dukes' A, B and C patients respectively, 16.2% following anterior resection and 19.3% following abdominoperineal resection. Nine papers (1,176 patients) reported LR rates of 10% or less. LR was 7.1% in 1,033 patients having total mesorectal excision and 12.4% in 476 patients having extended pelvic lymphadenectomy. Routine cytocidal stump washout in 1,364 patients was associated with 12.2% LR, however a higher proportion (41%) also underwent total mesorectal excision. In 52% of cases, LR was reported to have occurred with no evidence of disseminated disease. Surgical technique is an important determinant of LR risk. LR rates of 10% or less can be achieved with surgery alone in expert hands.

Résumé

Les récidives locales (LR) représentent toujours un problème majeur après traitement chirurgical des cancers du rectum et les moyens de réduire cette incidence sont toujours sujets à controverse. Le but de cette étude est de faire une revue des résultats des séries publiées de traitement chirurgical sans traitement adjuvant. A l'aide de Medline les séries publiées entre janvier 1982 et décembre 1992 avec un follow-up portant sur au minimum 50 patients traités par une chirurgie curatrice sans traitement adjuvant ont été identifiés. Cinquante-et-un articles portant sur 10465 patients avec un taux de récidive locate moyen de 18.5% ont été publiés. Les récidives locales sont respectivement de 8,5% en case de Dukes A, 16,3% en cas de Dukes B, 28,6% en cas de Dukes C, 16,2% après résection antérieure basse et 19,3% après amputation abdomino-périnéale. Neuf articles (1176 patients) publient des récidives locales de moins de 10%. Le taux de récidive locale est de 7,1% chez 1033 patients ayant subi une excision totale du méso-rectum et de 12,4% chez 476 patients ayant subi une lymphadénectomie pelvienne étendue. Le lavage de routine du moignon rectal avec un cytostatique a été réalisé chez 1'364 patients avec un taux de récidive locale de 12,2% bien qu'une proportion élevée (41%) avait subi également une excision du méso-rectum. Dans 52% des cas, la récidive locale est observée alors même qu'il n'y a pas d'évidence d'une dissémination de la maladie. La technique chirurgicale est un facteur déterminant important dans la survenue d'une récidive locale. Des taux de récidive de 10% ou moins peuvent être obtenus avec la chirurgie seule réalisée par des mains expertes.

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  1. Gastrointestinal Surgical Unit, Flinders Medical Centre, 5042, Bedford Park, South Australia

    J. L. McCall, M. R. Cox & D. A. Wattchow

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McCall, J.L., Cox, M.R. & Wattchow, D.A. Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorect Dis 10, 126–132 (1995). https://doi.org/10.1007/BF00298532

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