Locally recurrent rectal cancer (LRRC) has a tremendous impact on prognosis as well as the quality of life. Because of the low incidence and various recurrence patterns, the treatment outcome of LRRC is not fully elucidated. The current study aimed to evaluate the prognosis and identify the prognosticators in patients with LRRC.
We conducted a multicenter study at 24 hospitals in Japan. Patients with primary rectal cancer who underwent curative resection between 1997 and 2012 and developed local recurrence only as a first recurrent event were recruited. The primary outcome of our study was overall survival (OS) after a diagnosis of LRRC.
Four hundred and ninety-eight patients were included in the study. Of these, 213 (42.8%) underwent surgical resection; this was associated with the best 5-year OS rate of 52%, followed by carbon ion/proton therapy (44%). Among LRRC patients, undifferentiated type, T4, high CEA level, and high CA19–9 level were independent prognosticators of OS (hazard ratio (HR) = 1.83, P = 0.008, HR = 1.54, P = 0.004, HR = 1.35, P = 0.03, and HR = 1.58, P = 0.003, respectively).
This large-scale cohort study showed that surgical resection led to a favorable prognosis compared to other treatments for LRRC. Therefore, surgical resection should be considered whenever feasible for LRRC patients. In addition, undifferentiated type, T4, and tumor marker (CEA and CA19–9) elevation were identified as independent prognostic factors for OS among patients with LRRC.
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Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT, Untereiner M, Leduc B, Francois E, Maurel J, Seitz JF, Buecher B, Mackiewicz R, Ducreux M, Bedenne L (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625. https://doi.org/10.1200/JCO.2006.06.7629
Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study G (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740. https://doi.org/10.1056/NEJMoa040694
Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, Peters WR Jr, Maun DC, Chang GJ, Herline A, Fichera A, Mutch MG, Wexner SD, Whiteford MH, Marks J, Birnbaum E, Margolin DA, Larson DW, Marcello PW, Posner MC, Read TE, Monson JRT, Wren SM, Pisters PWT, Nelson H (2019) Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269(4):589–595. https://doi.org/10.1097/SLA.0000000000003002
Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, Group CIS (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332. https://doi.org/10.1056/NEJMoa1414882
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774. https://doi.org/10.1016/S1470-2045(14)70205-0
Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Wilson K, Hague W, Simes J, Australasian Gastro-Intestinal Trials Group Ai (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg 269(4):596–602. https://doi.org/10.1097/SLA.0000000000003021
Westberg K, Palmer G, Hjern F, Johansson H, Holm T, Martling A (2018) Management and prognosis of locally recurrent rectal cancer - a national population-based study. Eur J Surg Oncol 44(1):100–107. https://doi.org/10.1016/j.ejso.2017.11.013
Yang TX, Morris DL, Chua TC (2013) Pelvic exenteration for rectal cancer: a systematic review. Dis Colon Rectum 56(4):519–531. https://doi.org/10.1097/DCR.0b013e31827a7868
Westberg K, Palmer G, Hjern F, Holm T, Martling A (2019) Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer. Br J Surg 106(6):790–798. https://doi.org/10.1002/bjs.11098
Detering R, Karthaus EG, Borstlap WAA, Marijnen CAM, van de Velde CJH, Bemelman WA, Beets GL, Tanis PJ, Aalbers AGJ, Dutch Snapshot Research G (2019) Treatment and survival of locally recurrent rectal cancer: a cross-sectional population study 15 years after the Dutch TME trial. Eur J Surg Oncol 45:2059–2069. https://doi.org/10.1016/j.ejso.2019.06.016
Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K, Japanese Society for Cancer of the C, Rectum (2019) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42. https://doi.org/10.1007/s10147-019-01485-z
Nielsen M, Rasmussen P, Pedersen B, Hagemann-Madsen R, Lindegaard J, Laurberg S (2015) Early and late outcomes of surgery for locally recurrent rectal cancer: a prospective 10-year study in the total mesorectal excision era. Ann Surg Oncol 22(8):2677–2684. https://doi.org/10.1245/s10434-014-4317-y
Denost Q, Faucheron JL, Lefevre JH, Panis Y, Cotte E, Rouanet P, Jafari M, Capdepont M, Rullier E, Association Francaise de C (2015) French current management and oncological results of locally recurrent rectal cancer. Eur J Surg Oncol 41(12):1645–1652. https://doi.org/10.1016/j.ejso.2015.09.019
Du P, Burke JP, Khoury W, Lavery IC, Kiran RP, Remzi FH, Dietz DW (2016) Factors associated with the location of local rectal cancer recurrence and predictors of survival. Int J Color Dis 31(4):825–832. https://doi.org/10.1007/s00384-016-2526-5
Yun JA, Huh JW, Kim HC, Park YA, Cho YB, Yun SH, Lee WY, Chun HK (2016) Local recurrence after curative resection for rectal carcinoma: the role of surgical resection. Medicine (Baltimore) 95(27):e3942. https://doi.org/10.1097/MD.0000000000003942
PelvEx C (2018) Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer. Br J Surg 105(6):650–657. https://doi.org/10.1002/bjs.10734
Bhangu A, Ali SM, Cunningham D, Brown G, Tekkis P (2013) Comparison of long-term survival outcome of operative vs nonoperative management of recurrent rectal cancer. Color Dis 15(2):156–163. https://doi.org/10.1111/j.1463-1318.2012.03123.x
Shinoto M, Yamada S, Okamoto M, Shioyama Y, Ohno T, Nakano T, Nemoto K, Isozaki Y, Kawashiro S, Tsuji H, Kamada T (2019) Carbon-ion radiotherapy for locally recurrent rectal cancer: Japan Carbon-ion Radiation Oncology Study Group (J-CROS) study 1404 rectum. Radiother Oncol 132:236–240. https://doi.org/10.1016/j.radonc.2018.10.007
Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the C, Rectum (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17(1):1–29. https://doi.org/10.1007/s10147-011-0315-2
Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49(11):1663–1672. https://doi.org/10.1007/s10350-006-0714-z
Hida K, Okamura R, Sakai Y, Konishi T, Akagi T, Yamaguchi T, Akiyoshi T, Fukuda M, Yamamoto S, Yamamoto M, Nishigori T, Kawada K, Hasegawa S, Morita S, Watanabe M, Japan Society of Laparoscopic Colorectal S (2018) Open versus laparoscopic surgery for advanced low rectal cancer: a large, multicenter, propensity score matched cohort study in Japan. Ann Surg 268(2):318–324. https://doi.org/10.1097/SLA.0000000000002329
The data of this study was acquired from 24 hospitals, participating in the Japanese Study Group for Postoperative Follow-up of CRC. We appreciate the representatives of each hospital: I. Takemasa (Sapporo Medical University); K. Hakamada (Hirosaki University); H. Kameyama (Niigata University); Y. Takii (Niigata Cancer Center Hospital); H. Ueno (National Defense Medical College); H. Ozawa (Tochigi Cancer Center); S. Ishihara (Tokyo University); K. Takahashi (Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital); Y. Kanemitsu (National Cancer Center Hospital); M Itabashi (Tokyo Women’s Medical University); T. Kiyomatsu (National Center for Global Health and Medicine); Y Kinugasa (Tokyo Medical and Dental University); K. Okabayashi (Keio University); Y. Hashiguchi (Teikyo University); T. Masaki (Kyorin University); M. Watanabe (Kitasato University); A. Shiomi (Shizuoka Cancer Center); T. Hanai (Fujita Health University); K. Komori (Aichi Cancer Center Hospital); Y. Sakai (Kyoto University); M. Ohue (Osaka International Cancer Institute); S. Noura (Osaka Rosai Hospital); N. Tomita (Hyogo College of Medicine); and Y. Akagi (Kurume University).
The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.
The Japanese Study Group for Postoperative Follow-up of Colorectal Cancer financially supported this work.
Ethics approval and consent to participate
The study was approved by the Central Institutional Review Board (Tokyo Medical and Dental University No. M2017–268). Informed consent was obtained from all participants included in the study.
Consent for publication
Additional informed consent was obtained from all participants whose identifying information is included in this article.
Conflict of interest
All authors declare no competing interests.
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Matsuyama, T., Yamauchi, S., Masuda, T. et al. Treatment and subsequent prognosis in locally recurrent rectal cancer: a multicenter retrospective study of 498 patients. Int J Colorectal Dis (2021). https://doi.org/10.1007/s00384-021-03856-3
- Rectal cancer
- Local recurrence
- Over-all survival