Clinical Presentation and Classifications

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.