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Oncological Outcomes

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Multimodal Treatment of Recurrent Pelvic Colorectal Cancer

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Pelvic recurrence of colorectal cancer (PRCRC) is a common problem after curative colorectal resection for colorectal adenocarcinoma, even in the neoadjuvant treatment age, with an incidence varying between 5% and 50% [1, 2]. Although there have been distinct improvements of therapeutic algorithms in managing systemic hepatic and pulmonary colorectal metastasis, there is no general acceptance of the same radical approach for isolated locally recurrent rectal cancer (LRRC) [3, 4]. In the absence of any treatment, survival of patients with PRCRC is poor and is associated with severe and unpleasant symptoms, such as pain, rectal bleeding, bowel or ureter occlusion, tenesmus, enterocutaneous fistulas, and ulcerating skin lesions [1]. Palliative radiotherapy (RT) alone or in combination with chemotherapy can achieve temporary symptomatic improvement in the majority of patients, but 5-year survival is usually <5% [5, 6]. Palliative surgery can prolong survival, but exposes the patient to substantial postoperative morbidity/mortality [5, 6]. Complete surgical resection with clear circumferential and distal margins (R0), in association with multimodal treatment (preoperative radiochemotherapy or intraoperative RT), remains the best option for cure after a PRCRC. The reported 5-year survival rates vary from 22 to 58% after obtaining R0 resection [7–9]. Therefore, it is essential to: (1) predict failure patterns, and (2) accurately stratify prognosis in relation to the different planned treatments so that appropriate therapy can be selected and proposed. This chapter discusses oncological outcomes of patients with PRCRC resulting from different treatment types.

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Authors and Affiliations

  1. Emergency Department, 3rd Department of Surgery, Policlinico Umberto I, Sapienza University Hospital, Rome, Italy

    Filippo La Torre

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  1. Filippo La Torre
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  2. Marco La Torre
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Correspondence to Filippo La Torre .

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  1. Gastrointestinal Surgical Oncology Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy

    Giovanni Maria Romano

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La Torre, F., La Torre, M. (2016). Oncological Outcomes. In: Romano, G.M. (eds) Multimodal Treatment of Recurrent Pelvic Colorectal Cancer. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5767-8_11

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  • DOI: https://doi.org/10.1007/978-88-470-5767-8_11

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5766-1

  • Online ISBN: 978-88-470-5767-8

  • eBook Packages: MedicineMedicine (R0)

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