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Locally Advanced and Recurrent Cancer

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Multidisciplinary Treatment of Colorectal Cancer

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Abstract

A successful treatment of locally advanced and recurrent rectal cancer is based on the responsibility of the surgeon to perform a radical resection. Planning of treatment starts with imaging with a pelvic MRI and a CT scan of chest and the abdomen. Neoadjuvant chemoradiation is given to achieve downstaging and downsizing. After a waiting period of at least 6 weeks, a total mesorectal excision is performed with often an extra-anatomical extension based on the initial imaging. Reconstruction using several types of pedicled flaps is often necessary to close the defect of the pelvic floor.

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References

  1. Peeters KC, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group. 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;246:693–701.

    Article  Google Scholar 

  2. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009;373:811–20.

    Article  Google Scholar 

  3. Wiggers T, van de Velde CJ. Reduction ‘by half’. The need for standardised surgical technique in radiotherapy studies for rectal cancer. Eur J Surg. 1999;165:407–9.

    Article  CAS  Google Scholar 

  4. den Dulk M, Marijnen CAM, Putter H, et al. Risk factors for adverse outcome in patients with rectal cancer treated with an abdomino perineal resection in the TME trial. Ann Surg. 2007;246:83–90.

    Article  Google Scholar 

  5. Nagtegaal ID, Gosens MJ, Marijnen CA, et al. Combinations of tumor and treatment parameters are more discriminative for prognosis than the present TNM system in rectal cancer. J Clin Oncol. 2007;25:1647–50.

    Article  Google Scholar 

  6. Brown G, Davies S, Williams GT, et al. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer. 2004;91:23–9.

    Article  CAS  Google Scholar 

  7. Bujko K, Kepka L, Michalski W, et al. Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol. 2006;80:4–12.

    Article  Google Scholar 

  8. Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–7; discussion 7–8.

    PubMed  PubMed Central  Google Scholar 

  9. Glynne-Jones R, Hughes R. Critical appraisal of the ‘wait and see’ approach in rectal cancer for clinical complete responders after chemoradiation. Br J Surg. 2012;99(7):897–909.

    Article  CAS  Google Scholar 

  10. Martens MH, Maas M, Heijnen LA, et al. Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. J Natl Cancer Inst. 2016;108(12):djw171.

    Article  Google Scholar 

  11. van Dijk TH, Havenga K, Beukema J, et al. Short-course radiation therapy, neoadjuvant bevacizumab, capecitabine and oxaliplatin, and radical resection of primary tumor and metastases in primary stage IV rectal cancer: a phase II multicenter study of the Dutch Colorectal Cancer Group. Abstract 53606 ASCO. 2010;28(15):3638–8.

    Google Scholar 

  12. Rombouts AJM, Hugen N, Elferink MAG, Nagtegaal ID, de Wilt JHW. Treatment interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients: a population-based study. Ann Surg Oncol. 2016;23(11):3593–601.

    Article  CAS  Google Scholar 

  13. Austin KK, Solomon MJ. Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum. 2009;52:1223–33.

    Article  Google Scholar 

  14. Kusters M, Slater A, Muirhead R, et al. What to do with lateral nodal disease in low locally advanced rectal cancer? A call for further reflection and research. Dis Colon Rectum. 2017;60(6):577–85.

    Article  Google Scholar 

  15. Ogura A, Konishi T, Cunningham C, et al. Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol. 2019;37(1):33–43.

    Article  CAS  Google Scholar 

  16. Holm T, Ljung A, Haggmark T, et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007;94:232–8.

    Article  CAS  Google Scholar 

  17. West NP, Anderin C, Smith KJ, et al. European Extralevator Abdominoperineal Excision Study Group. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010;97:588–99.

    Article  CAS  Google Scholar 

  18. Hellinga J, Khoe PC, van Etten B, et al. Fasciocutaneous lotus petal flap for perineal wound reconstruction after extralevator abdominoperineal excision: application for reconstruction of the pelvic floor and creation of a neovagina. Ann Surg Oncol. 2016;23(12):4073–9.

    Article  Google Scholar 

  19. Pusic AL, Mehrara BJ. Vaginal reconstruction: an algorithm approach to defect classification and flap reconstruction. J Surg Oncol. 2006;94:515–21. Review.

    Article  Google Scholar 

  20. van den Brink M, Stiggelbout AM, van den Hout WB, et al. Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. J Clin Oncol. 2004;22:3958–64.

    Article  Google Scholar 

  21. Franke J, Rosenzweig S, Reinartz P, et al. Value of positron emission tomography (18F-FDG-PET) in the diagnosis of recurrent rectal cancer. Chirurg. 2000;71:80–5.

    CAS  PubMed  Google Scholar 

  22. van der Meij W, Rombouts AJ, Rütten H, Bremers AJ, de Wilt JH. Treatment of locally recurrent rectal carcinoma in previously (chemo)irradiated patients: a review. Dis Colon Rectum. 2016;59(2):148–56.

    Article  Google Scholar 

  23. Boyle KM, Sagar PM, Chalmers AG, et al. Surgery for locally recurrent rectal cancer. Dis Colon Rectum. 2005;48:929–37.

    Article  Google Scholar 

  24. Wiggers T, Mannaerts GH, Marinelli AW, et al. Surgery for locally recurrent rectal cancer. Color Dis. 2003;5:504–7.

    Article  CAS  Google Scholar 

  25. Knol HP, Hanssens PE, Rutten HJ, et al. Effect of radiation therapy alone or in combination with surgery and/or chemotherapy on tumor and symptom control of recurrent rectal cancer. Strahlenther Onkol. 1997;173:43–9.

    Article  CAS  Google Scholar 

  26. Wiggers T, de Vries MR, Veeze-Kuypers B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum. 1996;39:323–8.

    Article  CAS  Google Scholar 

  27. van Zoggel DMGI, Bosman SJ, Kusters M, Nieuwenhuijzen GAP, Cnossen JS, Creemers GJ, van Lijnschoten G, Rutten HJT. Preliminary results of a cohort study of induction chemotherapy-based treatment for locally recurrent rectal cancer. Br J Surg. 2018;105(4):447–52.

    Article  Google Scholar 

  28. Kusters M, Valentini V, Calvo FA, et al. Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases. Ann Oncol. 2010;21:1279–84.

    Article  CAS  Google Scholar 

  29. Valentini V, Morganti AG, Gambacorta MA, et al. Study Group for Therapies of Rectal Malignancies (STORM). Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: a multicentric phase II study. Int J Radiat Oncol Biol Phys. 2006;64:1129–39.

    Article  Google Scholar 

  30. Rutten HJ, Mannaerts GH, Martijn H, et al. Intraoperative radiotherapy for locally recurrent rectal cancer in The Netherlands. Eur J Surg Oncol. 2000;26(Suppl A):S16–20.

    PubMed  Google Scholar 

  31. Doornebosch PG, Ferenschild FT, de Wilt JH, et al. Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Dis Colon Rectum. 2010;53:1234–9.

    Article  Google Scholar 

  32. Mannaerts GH, Rutten HJ, Martijn H, et al. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum. 2001;44:806–14.

    Article  CAS  Google Scholar 

  33. Enker WE, Kafka NJ, Martz J. Planes of sharp pelvic dissection for primary, locally advanced, or recurrent rectal cancer. Semin Surg Oncol. 2000;18:199–206.

    Article  CAS  Google Scholar 

  34. Logmans A, van Lent M, van Geel AN, et al. The pedicled omentoplasty, a simple and effective surgical technique to acquire a safe pelvic radiation field; theoretical and practical aspects. Radiother Oncol. 1994;33:269–71.

    Article  CAS  Google Scholar 

  35. Borel Rinkes IH, Wiggers T. Gracilis muscle flap in the treatment of persistent, infected pelvic necrosis. Eur J Surg. 1999;165:390–1.

    Article  CAS  Google Scholar 

  36. Mannaerts GH, Rutten HJ, Martijn H, et al. Effects on functional outcome following IORT containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 2002;54:1082–8.

    Article  Google Scholar 

  37. Mannaerts GH, Schijven MP, Hendrikx A, Martijn H, et al. Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer. Eur J Surg Oncol. 2001;27:265–72.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    K. Havenga & A. W. Wijsmuller

  2. Incision KIT Royal Tropical Institute, Amsterdam, The Netherlands

    T. Wiggers

Authors
  1. K. Havenga
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  2. A. W. Wijsmuller
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  3. T. Wiggers
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Corresponding author

Correspondence to K. Havenga .

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Editors and Affiliations

  1. Department of Surgery, Odense University Hospital, Svendborg, Denmark

    Gunnar Baatrup

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Havenga, K., Wijsmuller, A.W., Wiggers, T. (2021). Locally Advanced and Recurrent Cancer. In: Baatrup, G. (eds) Multidisciplinary Treatment of Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-58846-5_13

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  • DOI: https://doi.org/10.1007/978-3-030-58846-5_13

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  • Print ISBN: 978-3-030-58845-8

  • Online ISBN: 978-3-030-58846-5

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