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Management of Locally Advanced and Recurrent Rectal Cancer

Chapter

Abstract

The management of locally advanced primary rectal cancer and locally recurrent rectal cancer is challenging. The fundamental principle in the management of these cancers resides in complete en bloc resection with a clear resection margin. In appropriately selected cases, 5 year survivals of 50 % have been reported. The management of rectal cancers, particularly that of locally advanced primary rectal cancer or locally recurrent rectal cancer has evolved to become a subspecialty within colorectal surgery. Despite the established role of pelvic exenteration for locally recurrent rectal cancers, it is somewhat disappointing that most patients who develop local recurrence are not being considered for onward referral for consideration of pelvic exenteration. This chapter provides an overview of the management of patients with locally advanced and recurrent rectal cancer but also highlights some of the contentious issues surrounding patient selection for surgery and modern breakthroughs in the surgical approach.

Keywords

Rectal cancer Locally advanced rectal cancer Recurrent rectal cancer Pelvic exenteration Local recurrence Multi-visceral resection Extended radical resection Abdomino-sacral resection R0 

References

  1. 1.
    Bhangu A, Ali S, Darzi A, Brown G, Tekkis P. Meta-analysis of survival based on resection margin status following surgery for recurrent rectal cancer. Colorectal Dis. 2012;14(12):1457–66.CrossRefPubMedGoogle Scholar
  2. 2.
    Solomon M. Re-exenteration for recurrent rectal cancer. Dis Colon Rectum. 2013;56(1):4–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Heriot A, Byrne C, Lee P, Dobbs B, Tilney H, Solomon M, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum. 2008;51:284–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Hahnloser D, Nelson H, Gunderson L, Hassan I, Haddock M, O’Connell M, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg. 2003;237:502–8.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Boyle K, Sagar P, Chalmers A, Sebag-Montefiore D, Cairns A, Eardley I. Surgery for locally recurrent rectal cancer. Dis Colon Rectum. 2005;48(5):929–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Rahbari N, Ulrich A, Bruckner T, Münter M, Nickles A, Contin P, et al. Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? Ann Surg. 2011;253(3):522–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Austin K, Young J, Solomon M. Quality of life of survivors after pelvic exenteration for rectal cancer. Dis Colon Rectum. 2010;53(8):1121–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Esnaola N, Cantor S, Johnson M, Mirza A, Miller A, Curley S, et al. Pain and quality of life after treatment in patients with locally recurrent rectal cancer. J Clin Oncol. 2002;20(21):4361–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Heald R, Ryall R. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;327(8496):1479–82.CrossRefGoogle Scholar
  10. 10.
    Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor J, Schmocker S, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19(7):2212–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Taylor F, Mangat N, Swift I, Brown G. Proforma-based reporting in rectal cancer. Cancer Imaging. 2010;10(1A):S142–50.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Peeters K, Marijnen C, Nagtegaal I, Kranenbarg E, Putter H, Wiggers T, et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246(5):693–701.CrossRefPubMedGoogle Scholar
  13. 13.
    Ngan S, Burmeister B, Fisher R, Solomon M, Goldstein D, Joseph D, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012;30(31):3827–33.CrossRefPubMedGoogle Scholar
  14. 14.
    McDermott F, Hughes E, Pihl E, Johnson W, Price A. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg. 1985;72:34–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Rao A, Kagan A, Chan P, Gilbert H, Nussbaum H, Hintz B. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer. 1981;48(6):1492–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Sagar P, Pemberton J. Surgical management of locally recurrent rectal cancer. Br J Surg. 1996;83(3):293–304.CrossRefPubMedGoogle Scholar
  17. 17.
    Miner T, Jaques D, Paty P, Guillem J, Wong W. Symptom control in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2003;10(1):72–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Pacini P, Cionini L, Pirtoli L, Ciatto S, Tucci E, Sebaste L. Symptomatic recurrences of carcinoma of the rectum and sigmoid. The influence of radiotherapy on the quality of life. Dis Colon Rectum. 1986;29(12):865–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Konski A, Suh W, Herman J, Blackstock AJ, Hong T, Poggi M, et al. ACR Appropriateness Criteria®-recurrent rectal cancer. Gastrointest Cancer Res. 2012;5(1):3–12.Google Scholar
  20. 20.
    Heriot A, Tekkis P, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis. 2006;8:733–47.CrossRefPubMedGoogle Scholar
  21. 21.
    Lopez-Kostner F, Fazio V, Vignali A, Rybicki L, Lavery I. Locally recurrent rectal cancer predictors and success of salvage surgery. Dis Colon Rectum. 2001;44:173–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Ogunbiyi O, Mckenna K, Birnhaum E, Fleshman J, Kodner I. Aggressive management of recurrent rectal cancer—is it worthwhile? Dis Colon Rectum. 1997;40:150–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Watson A, Lolohea S, Robertson G, Frizelle F. The role of positron emission tomography in the management of recurrent colorectal cancer: a review. Dis Colon Rectum. 2007;50(1):102–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Davey K, Heriot A, Mackay J, Drummond E, Hogg A, Ngan S, et al. The impact of 18-fluorodeoxyglucose positron emission tomography-computed tomography on the staging and management of primary rectal cancer. Dis Colon Rectum. 2008;51(7):997–1003.CrossRefPubMedGoogle Scholar
  25. 25.
    Vogel W, Wiering B, Corstens F, Ruers T, Oyen W. Colorectal cancer: the role of PET/CT in recurrence. Cancer Imaging. 2005;5:S143–9.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Mirnezami A, Sagar P, Kavanagh D, Witherspoon P, Lee P, Winter D. Clinical algorithms for the surgical management of locally recurrent rectal cancer. Dis Colon Rectum. 2010;53(9):1248–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Messiou C, Chalmers A, Boyle K, Wilson D, Sagar P. Pre-operative MR assessment of recurrent rectal cancer. Br J Radiol. 2008;81:468–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Dresen R, Kusters M, Daniels-Gooszen A, Cappendijk V, Nieuwenhuijzen G, Kessels A, et al. Absence of tumor invasion into pelvic structures in locally recurrent rectal cancer: prediction with preoperative MR imaging. Radiology. 2010;256(1):143–50.CrossRefPubMedGoogle Scholar
  29. 29.
    Lundstedt C, Stridbeck H, Andersson R, Tranberg K, Andren-Sandberg A. Tumor seeding occurring after fine needle biopsy of abdominal malignancies. Acta Radiol. 1991;32(6):518–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Smith E. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology. 1991;178(1):253–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Austin K, Solomon M. Pelvic exenteration with en bloc iliac resection for lateral wall involvement. Dis Colon Rectum. 2009;52(7):1223–33.CrossRefPubMedGoogle Scholar
  32. 32.
    Hartley J, Lopez R, Paty P, Wong W, Cohen A, Guillem J. Resection of locally recurrent colorectal cancer in the presence of distant metastases: can it be justified? Ann Surg Oncol. 2003;3:22–33.Google Scholar
  33. 33.
    Maetani S, Onodera H, Nishikawa T, Morimoto H, Ida K, Kitamura O, et al. Significance of local recurrence of rectal cancer as a local or disseminated disease. Br J Surg. 1998;85:521–5.CrossRefPubMedGoogle Scholar
  34. 34.
    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;88:988–93.CrossRefPubMedGoogle Scholar
  35. 35.
    Zoucas E, Frederiksen S, Lydrup M, Månsson W, Gustafson P, Alberius P. Pelvic exenteration for advanced and recurrent malignancy. World J Surg. 2010;34(9):2177–84.CrossRefPubMedGoogle Scholar
  36. 36.
    Pawlik T, Skibber J, Rodriguez-Bigas M. Educational review pelvic exenteration for advanced pelvic malignancies. Ann Surg Oncol. 2006;13(5):612–23.CrossRefPubMedGoogle Scholar
  37. 37.
    Gannon C, Zager J, Chang G, Feig B, Wood C, Skibber J, et al. Pelvic exenteration affords safe and durable treatment for locally advanced rectal carcinoma. Ann Surg Oncol. 2007;14(6):1870–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Suzuki K, Dozois R, Devine R, Nelson H, Weaver A, Gunderson L, et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum. 1996;39(7):730–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Attiyeh F, Ellis H, Killingback M, Oates G, Schofield P, Staab H, et al. Symposium: the management of recurrent colorectal cancer. Int J Colorectal Dis. 1986;1(3):133–51.CrossRefPubMedGoogle Scholar
  40. 40.
    Schwarzbach M, Hormann Y, Hinz U, Leowardi C, Böckler D, Mechtersheimer G, et al. Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg. 2006;44(1):46–55.CrossRefPubMedGoogle Scholar
  41. 41.
    Song T, Harris EJ, Raghavan S, Norton J. Major blood vessel reconstruction during sarcoma surgery. Arch Surg. 2009;144:817–22.CrossRefPubMedGoogle Scholar
  42. 42.
    Brooks A, Gold J, Graham D, Boland P, Lewis J, Brennan M, et al. Resection of the sciatic, peroneal, or tibial nerves: assessment of functional status. Ann Surg Oncol. 2002;9(1):41–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Fuchs B, Davis A, Wunder J, Bell R, Masri B, Isler M, et al. Sciatic nerve resection in the thigh: a functional evaluation. Clin Orthop Relat Res. 2001;382:34–41.CrossRefPubMedGoogle Scholar
  44. 44.
    Bickels J, Wittig J, Kollender Y, Kellar-Graney K, Malawer M, Meller I. Sciatic nerve resection: is that truly an indication for amputation? Clin Orthop Relat Res. 2002;399:201–4.CrossRefPubMedGoogle Scholar
  45. 45.
    Nielsen M, Rasmussen P, Keller J, Laurberg S. Preliminary experience with external hemipelvectomy for locally advanced and recurrent pelvic carcinoma. Colorectal Dis. 2011;14:152–6.CrossRefGoogle Scholar
  46. 46.
    Wedemeyer C, Kauthe M. Hemipelvectomy- only a salvage therapy? Orthop Rev. 2011;3(e4):12–9.Google Scholar
  47. 47.
    Baliski C, Schachar N, McKinnon J, Stuart G, Temple W. Hemipelvectomy: a changing perspective for a rare procedure. Can J Surg. 2004;47:99–103.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Hamanishi J, Higuchi T, Mandai M, Fukuhara K, An M, Nakayama T, et al. Intractable recurrent cervical cancer with pelvic bone involvement successfully treated with external hemipelvectomy. J Obstet Gynaecol Res. 2008;34(1):112–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Apffelstaedt J, Driscoll D, Spellman J, Velez A, Gibbs J, Karakousis C. Complications and outcome of external hemipelvectomy in the management of pelvic tumors. Ann Surg Oncol. 1996;3(3):304–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Wanebo H, Whitehill R, Gaker D, Wang G, Morgan R, Constable W. Composite pelvic resection. Arch Surg. 1987;122:1401–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Harji D, Griffiths B, McArthur D, Sagar P. Surgery for recurrent rectal cancer: higher and wider? Colorectal Dis. 2012;15:139–45.CrossRefGoogle Scholar
  52. 52.
    Fourney D, Rhines L, Hentschel S, Skibber J, Wolinsky J, Weber K, et al. En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine. 2005;3(2):111–22.CrossRefPubMedGoogle Scholar
  53. 53.
    Milne T, Solomon M, Lee P, Young J, Stalley P, Harrison J. Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg. 2013;258:1007–13.CrossRefPubMedGoogle Scholar
  54. 54.
    Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum. 2004;47:2047–53.CrossRefPubMedGoogle Scholar
  55. 55.
    Melton G, Paty P, Boland P, Healey J, Savatta S, Casas-Ganem J, et al. Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. Dis Colon Rectum. 2006;49(8):1099–107.CrossRefPubMedGoogle Scholar
  56. 56.
    Mannaerts G, Rutten H, Martijn H, Groen G, Hanssens P, Wiggers T. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum. 2001;44(6):806–14.CrossRefPubMedGoogle Scholar
  57. 57.
    Sagar P, Gonsalves S, Heath R, Phillips N, Chalmers A. Composite abdominosacral resection for recurrent rectal cancer. Br J Surg. 2009;96(2):191–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Dozois E, Privitera A, Holubar S, Aldrete J, Sim F, Rose P, et al. High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved? J Surg Oncol. 2011;103:105–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Wanebo H, Antoniuk P, Koness R, Levy A, Vezeridis M, Cohen S, et al. Pelvic resection of recurrent rectal cancer. Technical considerations and outcomes. Dis Colon Rectum. 1999;42(11):1438–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Yeung R, Moffat F, Falk R. Pelvic exenteration for recurrent and extensive primary colorectal adenocarcinoma. Cancer. 1993;72:1853.CrossRefPubMedGoogle Scholar
  61. 61.
    Finlayson C, Eisenberg B. Palliative pelvic exenteration: patient selection and results. Oncology. 1996;10(4):479–84.PubMedGoogle Scholar
  62. 62.
    Vermaas M, Ferenschild F, Nuyttens J, Marinelli A, Wiggers T, van der Sijp J, et al. Preoperative radiotherapy improves outcome in recurrent rectal cancer. Dis Colon Rectum. 2005;48:918–28.CrossRefPubMedGoogle Scholar
  63. 63.
    Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol. 2008;9(4):367–75.CrossRefPubMedGoogle Scholar
  64. 64.
    Dresen R, Gosen M, Martijn H, Nieuwenhuijzen G, Creemers G, Daniels-Gooszen A, et al. Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol. 2008;15(7):1937–47.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Ferenschild F, Vermaas M, Verhoef C, Dwarkasing R, Eggermont A, de Wilt J. Abdominosacral resection for locally advanced and recurrent rectal cancer. Br J Surg. 2009;96(11):1341–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Teixeira S, Ferenschild F, Solomon M, Rodwell L, Harrison J, Young J, et al. Urological leaks after pelvic exenterations comparing formation of colonic and ileal conduits. Eur J Surg Oncol. 2011;38(4):361–6.CrossRefGoogle Scholar
  67. 67.
    Angioli R, Panici P, Mirhashemi R, Mendez L, Cantuaria G, Basile S, et al. Continent urinary diversion and low colorectal anastomosis after pelvic exenteration. Quality of life and complication risk. Crit Rev Oncol Hematol. 2003;48(3):281–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Husain A, Curtin J, Brown C, Chi D, Hoskins W, Poynor E, et al. Continent urinary diversion and low-rectal anastomosis in patients undergoing exenterative procedures for recurrent gynecologic malignancies. Gynecol Oncol. 2000;78(2):208–11.CrossRefPubMedGoogle Scholar
  69. 69.
    Koda K, Tobe T, Takiguchi N, Oda K, Ito H, Miyazaki M. Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions. Br J Surg. 2002;89(10):1286–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Jacombs A, Rome P, Harrison JD, Solomon M. Assessment of the selection process for myocutaneous flap repair and surgical complications in pelvic exenteration surgery. Br J Surg. 2013;100(4):561–7.CrossRefPubMedGoogle Scholar
  71. 71.
    Boccola M, Rozena W, Ek E, Teh B, Croxford M, Grinsell D. Inferior gluteal artery myocutaneous island transposition flap reconstruction of irradiated perineal defects. J Plas Reconst Aesthet Surg. 2010;63(7):1169–75.CrossRefGoogle Scholar
  72. 72.
    Di Mauro D, D’Hoore A, Penninckx F, De Wever I, Vergote I, Hierner R. V-Y Bilateral gluteus maximus myocutaneous advancement flap in the reconstruction of large perineal defects after resection of pelvic malignancies. Colorectal Dis. 2009;11(5):508–12.CrossRefPubMedGoogle Scholar
  73. 73.
    Hainsworth A, Al Akash M, Roblin P, Mohanna P, Ross D, George M. Perineal reconstruction after abdominoperineal excision using inferior gluteal artery perforator flaps. Br J Surg. 2012;99(4):584–8.CrossRefPubMedGoogle Scholar
  74. 74.
    Luo S, Raffoul W, Piaget F, Egloff D. Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction. Plast Reconstr Surg. 2000;105(1):171–3.CrossRefPubMedGoogle Scholar
  75. 75.
    Ferenschild F, Vermaas M, Verhoef C, Ansink A, Kirkels W, Eggermont A, et al. Total pelvic exenteration for primary and recurrent malignancies. World J Surg. 2009;33(7):1502–8.CrossRefPubMedCentralPubMedGoogle Scholar
  76. 76.
    Harris D, Davies M, Lucas M, Drew P, Carr N, Beynon J, et al. Multivisceral resection for primary locally advanced rectal carcinoma. Br J Surg. 2011;98:582–8.CrossRefPubMedGoogle Scholar
  77. 77.
    Jimenez R, Shoup M, Cohen A, Paty P, Guillem J, Wong W. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum. 2003;46(12):1619–25.CrossRefPubMedGoogle Scholar
  78. 78.
    Bell S, Dehni N, Chaouat M. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection. Br J Surg. 2005;92:482–6.CrossRefPubMedGoogle Scholar
  79. 79.
    López-Basave H, Morales-Vásquez F, Herrera-Gómez A, Rosciano A, Meneses-García A, Ruiz-Molina J. Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution. Cancer Manag Res. 2012;4:351–6.CrossRefPubMedCentralPubMedGoogle Scholar
  80. 80.
    Thaysen H, Jess P, Laurberg S. Health-related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer: a review. Colorectal Dis. 2012;14(7):797–803.CrossRefPubMedGoogle Scholar
  81. 81.
    You Y, Habiba H, Chang G, Rodriguez-bigas M, Skibber J. Prognostic value of quality of life and pain in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2011;18(4):989–96.CrossRefPubMedCentralPubMedGoogle Scholar
  82. 82.
    Miller A, Cantor S, Peoples G, Pearlstone D, Skibber J. Quality of life and cost effectiveness analysis of therapy for locally recurrent rectal cancer. Dis Colon Rectum. 2000;43(12):1695–701.CrossRefPubMedGoogle Scholar
  83. 83.
    Kusters M, Dresen R, Martijn H, Nieuwenhuijzen G, van de Velde C, van den Berg H, et al. Radicality of resection and survival after multimodality treatment is influenced by subsite of locally recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 2009;75(5):1444–9.CrossRefPubMedGoogle Scholar
  84. 84.
    Jiang Y, Wan Y, Liu Y, Wang X, Pan Y, Wu T, et al. Surgical outcomes for 187 patients with locally recurrent rectal cancer and analysis of prognostic factors. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(8):582–5.PubMedGoogle Scholar
  85. 85.
    Nielsen M, Rasmussen P, Lindegaard J, Laurberg S. A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis. 2012;14(9):1076–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Royal Prince Alfred HospitalCamperdownAustralia
  2. 2.Surgical Outcomes Research Centre (SOuRCe)CamperdownAustralia
  3. 3.Discipline of SurgeryUniversity of SydneyNewtownAustralia

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