Advertisement

Clinical Presentation and Classifications

  • Filippo La TorreEmail author
  • Giuseppe Giuliani
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

Despite optimization of different surgical techniques and the presence of several chemotherapy and radiotherapy protocols, pelvic colorectal cancer (CRC) recurrence remains a significant problem and a disabling psychophysical condition. Approximately 20% of patients will develop recurrence after surgery for colon cancer, whereas for patients who undergo total mesorectal excision (TME) and adjuvant or neoadjuvant therapy for rectal cancer, pelvic recurrence is estimated at between 2.6% and 32% [1]. Time from primary surgical resection to the diagnosis of recurrence can range from 12 to more than 36 months [2]. These patients have a poor prognosis and a high morbidity rate, with a median overall survival rate after diagnosis of 6–7 months if not treated. At the moment of recurrence diagnosis, 50% of patients present systemic disease. Radiotherapy associated or not with chemotherapy has a palliative purpose and can increase survival to 12–14 months [2]: in selected patients, surgical resection can be considered either as the only possibly curative treatment or as a step in multimodal treatment [2]. This chapter describes the principal clinical symptoms observed in a patient with recurrence and the primary system used to classify pelvic CRC recurrence.

Keywords

Rectal Cancer Total Mesorectal Excision Peritoneal Reflection Pelvic Recurrence Lateral Pelvic Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Heriot A, Kumar D (2000) Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2:126–137CrossRefPubMedGoogle Scholar
  2. 2.
    Heriot AG, Byrne CM, Lee P et al (2008) Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum 51:284–291CrossRefPubMedGoogle Scholar
  3. 3.
    Camilleri-Brennan J, Steele RJ (2001) The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol 27:349–353CrossRefPubMedGoogle Scholar
  4. 4.
    Palmer G, Martling A, Cedermark B, Holm T (2007) A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 14:447–454CrossRefPubMedGoogle Scholar
  5. 5.
    Kodeda K, Derwinger K, Gustavsson B, Nordgren S (2012) Local recurrence of rectal cancer: a population based cohort study of diagnosis, treatment and outcome. Colorectal Dis 14 e230–e237CrossRefPubMedGoogle Scholar
  6. 6.
    Hogan NM, Joyce MR (2012) Surgical management of locally recurrent rectal cancer. Int J Surg Oncol 2012:464380. doi:10.1155/2012/464380PubMedCentralPubMedGoogle Scholar
  7. 7.
    Salo JC, Paty PB, Guillem J et al (1999) Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol 6:171–177CrossRefPubMedGoogle Scholar
  8. 8.
    Hahnloser D, Nelson H, Gunderson LL et al (2003) Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 237:502–508PubMedCentralPubMedGoogle Scholar
  9. 9.
    Suzuki K, Gunderson LL, Devine RM et al (1995) Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer 75:939–952CrossRefPubMedGoogle Scholar
  10. 10.
    Brown G, Drury AE, Cunningham D, Husband JE (2003) CT detection of hydronephrosis in resected colorectal cancer: a predictor of recurrent disease. Clin Radiol 58:137–142CrossRefPubMedGoogle Scholar
  11. 11.
    Georgiou PA, Tekkis PP, Constantinides VA et al (2013) Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer. Eur J Cancer 49:72–81CrossRefPubMedGoogle Scholar
  12. 12.
    Enríquez-Navascués JM, Borda N, Lizerazu A et al (2011) Patterns of local recurrence in rectal cancer after a multidisciplinary approach. World J Gastroenterol 17:1674–1684PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Heriot AG, Tekkis PP, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis 8:733-747Google Scholar
  14. 14.
    Georgiou PA, Tekkis PP, Brown G (2011) Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options. Cancer Imaging 11:S103–S111PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE (1984) Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 53:1354–1362CrossRefPubMedGoogle Scholar
  16. 16.
    Guillem JG, Ruo L (1998) Strategies in operative therapy for locally recurrent rectal cancer. Semin Colon Rectal Surg 9:259–268Google Scholar
  17. 17.
    Moore HG, Shoup M, Riedel E et al (2004) Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum 47:1599–1606CrossRefPubMedGoogle Scholar
  18. 18.
    Wanebo HJ, Antoniuk P, Koness RJ et al (1999) Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 42:1438–1448CrossRefPubMedGoogle Scholar
  19. 19.
    Yamada K, Ishizawa T, Niwa K et al (2001) Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 88:988–993CrossRefPubMedGoogle Scholar
  20. 20.
    Boyle KM, Sagar PM, Chalmers AG et al (2005) Surgery for locally recurrent rectal cancer. Dis Colon Rectum 48:929–937CrossRefPubMedGoogle Scholar
  21. 21.
    Kusters M, Marijnen CA, van de Velde CJ et al (2010) Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol 36:470–476CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  1. 1.Emergency Department, 3rd Department of SurgeryPoliclinico Umberto I, Sapienza University HospitalRomeItaly

Personalised recommendations