Hydronephrosis Does Not Preclude Curative Resection of Pelvic Recurrences After Colorectal Surgery
- 55 Downloads
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.
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.
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.
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.
KeywordsHydronephrosis Colorectal cancer Recurrence Salvage
- 3.Welch JP, Donaldson GA. The clinical correlation of an autopsy study of recurrent colorectal cancer. Ann Surg 1979;4:496–502Google Scholar
- 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
- 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