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Annals of Surgical Oncology

, Volume 12, Issue 10, pp 786–792 | Cite as

Hydronephrosis Does Not Preclude Curative Resection of Pelvic Recurrences After Colorectal Surgery

  • Leonard R. Henry
  • Elin Sigurdson
  • Eric Ross
  • John P. Hoffman
Article

Abstract

Background

In one third of patients who die of rectal cancer, a pelvic recurrence after resection represents isolated disease for which re-resection may provide cure. These extensive resections can carry high morbidity. Proper patient selection is desirable but difficult. Hydronephrosis has been documented previously to portend a poor prognosis, and some consider it a contraindication to attempted resection. It was our goal to review our experience and either confirm or refute these conclusions.

Methods

We performed a retrospective analysis of 90 patients resected with curative intent for pelvic recurrence at our center from 1988 through 2003. Seventy-one records documented the preoperative presence or absence of hydronephrosis. Clinical and pathologic data were recorded. The groups with and without hydronephrosis were compared.

Results

There were 15 patients with hydronephrosis in this study and 56 without. Although patients with hydronephrosis had shorter overall survival, disease-free survival, and rate of local control, none of these differences was statistically significant. Patients in the hydronephrosis group were younger and had higher-stage primary tumors and larger recurrent tumors. Subsequently, they underwent more extensive resections and were more likely to be treated with adjuvant therapies. There was no difference in the rate of margin-negative resections between the groups.

Conclusions

Hydronephrosis correlates with younger patients with larger recurrent tumors undergoing more extensive operations and multimodality therapy but does not preclude curative (R0) resection or independently affect overall survival, disease-free survival, or local control. We believe that it should not be considered a contraindication to attempting curative resection.

Keywords

Hydronephrosis Colorectal cancer Recurrence Salvage 

References

  1. 1.
    Karanjia ND, Schache DJ, North WR, Heald RJ. “Close shave” in anterior resection. Br J Surg 1990;77:510–2PubMedGoogle Scholar
  2. 2.
    Carlsson U, Lasson A, Ekelund G. Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 1987;30:431–4PubMedGoogle Scholar
  3. 3.
    Welch JP, Donaldson GA. The clinical correlation of an autopsy study of recurrent colorectal cancer. Ann Surg 1979;4:496–502Google Scholar
  4. 4.
    Kakuda JT, Lamont JP, Chu DZJ, Paz IB. The role of pelvic exenteration in the management of recurrent rectal cancer. Am J Surg 2003;186:660–4CrossRefPubMedGoogle Scholar
  5. 5.
    Cheng C, Rodriguez-Bigas MA, Petrelli N. Is there a role for curative surgery for pelvic recurrence from rectal carcinoma in the presence of hydronephrosis? Am J Surg 2001;182:274–7Google Scholar
  6. 6.
    Rodriguez-Bigas MA, Herrera L, Petrelli NJ. Surgery for recurrent rectal adenocarcinoma in the presence of hydronephrosis. Am J Surg 1992;164:18–21PubMedGoogle Scholar
  7. 7.
    Maetani S, Onodera H, Nishikawa T, et al. Significance of local recurrence of rectal cancer as a local or disseminated disease. Br J Surg 1998;85:521–5CrossRefPubMedGoogle Scholar
  8. 8.
    Garcia-Aguilar J, Cromwell JW, Marra C, Lee SH, Madoff RD, Rothenberger DA. Treatment of locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1743–8PubMedGoogle Scholar
  9. 9.
    Lopez-Kostner F, Fazio VW, Vignali A, Rybicki LA, Lavery IC. Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 2001;44:173–8PubMedGoogle Scholar
  10. 10.
    Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994;220:586–95PubMedGoogle Scholar
  11. 11.
    Huguier M, Houry S, Barrier A. Local recurrence of cancer of the rectum. Am J Surg 2001;182:437–9CrossRefPubMedGoogle Scholar
  12. 12.
    Delpero JR, Pol B, Le Treut YP, et al. Surgical resection of locally recurrent colorectal adenocarcinoma. Br J Surg 1998;85:372–6CrossRefPubMedGoogle Scholar
  13. 13.
    Salo JC, Paty PB, Guillem J, Minsky BD, Harrison LB, Cohen AM. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol 1998;6:171–7CrossRefGoogle Scholar
  14. 14.
    Law WL, Chu KW. Resection of local recurrence of rectal cancer: results. World J Surg 2000;24:486–90CrossRefPubMedGoogle Scholar
  15. 15.
    Ogunbiyi OA, Mckenna K, Birnbaum EH, Fleshman JW, Kodner IJ. Aggressive surgical management of recurrent rectal cancer—is it worthwhile? Dis Colon Rectum 1997;40:150–5PubMedGoogle Scholar
  16. 16.
    Hahnloser D, Nelson H, Gunderson LL, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003;237:502–8CrossRefPubMedGoogle Scholar
  17. 17.
    Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T. Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 2001;88:988–93CrossRefPubMedGoogle Scholar
  18. 18.
    Lopez MJ, Kraybill WG, Downey RS, Johnston WD, Bricker EM. Exenterative surgery for locally advanced rectosigmoid cancers. Is it worthwhile? Surgery 1987;102:644–51Google Scholar
  19. 19.
    Kendal WS, Cripps C, Viertelhausen S, Stern H. Multimodality management of locally recurrent colorectal cancer. Surg Clin North Am 2002;82:1059–73CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Leonard R. Henry
    • 1
  • Elin Sigurdson
    • 1
  • Eric Ross
    • 2
  • John P. Hoffman
    • 1
  1. 1.Department of Surgical OncologyFox Chase Cancer CenterPhiladelphia
  2. 2.Department of BiostatisticsFox Chase Cancer CenterPhiladelphia

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