Advertisement

Indications for Surgery and Surgical Techniques

  • Andrea Belli
  • Francesco Bianco
  • Silvia De Franciscis
  • Giovanni M. RomanoEmail author
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

At the present time, there are no uniform guidelines for treating locally recurrent rectal cancer (LRRC), and patients affected by local recurrence should be referred exclusively to tertiary centers where all expertise needed to provide patients with optimal treatment is available. In fact, there are a number of different options for treating LRRC that should be evaluated in a multidisciplinary team workup of individual cases. Recurrence location and extent, together with the evaluation of previously administered treatment, should be taken into account when determining the appropriate treatment strategy. Systemic chemotherapy, radiotherapy (RT), radiochemotherapy (RCT), and surgery — alone or in combination — can all play a role in achieving cure, long-term overall survival (OS), and palliation. In the vast majority of studies, 40–50% of patients with local recurrence are considered amenable to surgical exploration; 30–40% of them are reported to have had an R0 resection [1, 2]. This implies that just 20–30% of patients with recurrent rectal cancer will undergo a potentially curative resection, but these data are affected by selection criteria and surgical expertise at the different reporting institutions.

Keywords

Pelvic Exenteration Recurrent Rectal Cancer Locally Recurrent Rectal Cancer Great Sciatic Notch Internal Iliac Vessel 
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.
    Bakx R, Visser O, Josso J et al (2008) Management of recurrent rectal cancer: a population based study in greater Amsterdam. World J Gastroenterol 14:6018–6023CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Palmer G, Martling A, Cedermark B et al (2007) A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 14:447–454CrossRefPubMedGoogle Scholar
  3. 3.
    Harji DP, Griffiths B, McArthur DR et al (2013) Surgery for recurrent rectal cancer: higher and wider? Colorectal Dis 15:139–145CrossRefPubMedGoogle Scholar
  4. 4.
    West NP, Anderin C, Smith KJ et al (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97:588–599CrossRefPubMedGoogle Scholar
  5. 5.
    Selvaggi F, Fucini C, Pellino G et al (2015) Outcome and prognostic factors of local recurrent rectal cancer: a pooled analysis of 150 patients. Tech Coloproctol 19:135–144CrossRefPubMedGoogle Scholar
  6. 6.
    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
  7. 7.
    Wilson RJ, Davies S, Yates D et al (2010) Impaired functional capacity is associated with allcause mortality after major elective intra-abdominal surgery. Br J Anaesth 105:297–303CrossRefPubMedGoogle Scholar
  8. 8.
    You YN, Habiba H, Chang GJ et al (2011) Prognostic value of quality of life and pain in patients with locally recurrent rectal cancer. Ann Surg Oncol 18:989–996CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Hartley JE, Lopez RA, Paty PB et al (2003) Resection of locally recurrent colorectal cancer in the presence of distant metastases: can it be justified? Ann Surg Oncol 10:227–233CrossRefPubMedGoogle Scholar
  10. 10.
    Rahbari NN, Ulrich AB, Bruckner T et al (2011) Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? Ann Surg 253:522–553CrossRefPubMedGoogle Scholar
  11. 11.
    Moore HG, Shoup M, Riedel E et al (2004) Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum 47:1599–1606CrossRefPubMedGoogle Scholar
  12. 12.
    Yiu R, Wong SK, Cromwell J et al (2001) Pelvic wall involvement denotes a poor prognosis in T4 rectal cancer. Dis Colon Rectum 44:1676–1681CrossRefPubMedGoogle Scholar
  13. 13.
    Beyond TME Collaborative (2013) Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 100:1009–1014CrossRefGoogle Scholar
  14. 14.
    Melton GB, Paty PB, Boland PJ et al (2006) Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. Dis Colon Rectum 49:1099–1107CrossRefPubMedGoogle Scholar
  15. 15.
    Ferenschild FT, Vermaas M, Verhoef C et al (2009) Abdominosacral resection for locally advanced and recurrent rectal cancer. Br J Surg 96:1341–1347CrossRefPubMedGoogle Scholar
  16. 16.
    Zacherl J, Schiessel R, Windhager R et al (1999) Abdominosacral resection of recurrent rectal cancer in the sacrum. Dis Colon Rectum 42:1035–1039 (discussion 1039–1040)CrossRefPubMedGoogle Scholar
  17. 17.
    Romano G, Belli G, Rotondano G (1995) Colorectal cancer–Diagnosis of recurrence Gastroin-test Endosc Clin N Am 5:831–841Google Scholar
  18. 18.
    Dozois EJ, Privitera A, Holubar SD et al (2011) High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved? J Surg Oncol 103:105–109CrossRefPubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    Austin KK, Solomon MJ (2009) Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rect 52:1223–33CrossRefGoogle Scholar
  21. 21.
    Shaikh I, Aston W, Hellawell G et al (2014) Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall. Tech Coloproctol 18:1161–1168CrossRefPubMedGoogle Scholar
  22. 22.
    Nielsen MB, Rasmussen P, Johnny K, Laurberg S (2012) Preliminary experience with external hemipelvectomy for locally advanced and recurrent pelvic carcinoma. Colorectal Dis 14:152–156CrossRefPubMedGoogle Scholar
  23. 23.
    Apffelstaedt JP, Driscoll DL, Spellman JE et al (1996) Complications and outcome of external hemipelvectomy in the management of pelvic tumors. Ann Surg Oncol 3:304–309CrossRefPubMedGoogle Scholar
  24. 24.
    Senchenkov A, Moran SL, Petty PM et al (2008) Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases. Ann Surg Oncol 15:355–363CrossRefPubMedGoogle Scholar
  25. 25.
    Wirbel RJ, Schulte M, Maier B et al (2000) Chondrosarcoma of the pelvis: oncologic and functional outcome. Sarcoma 4:161–168CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Fueglistaler P, Gurke L, Stierli P et al (2006) Major vascular resection and prosthetic replacement for retroperitoneal tumors. World J Surg 30:1344–1349CrossRefPubMedGoogle Scholar
  27. 27.
    McKay A, Motamedi M, Temple W et al (2007) Vascular reconstruction with the superficial femoral vein following major oncologic resection. J Surg Oncol 96:151–159CrossRefPubMedGoogle Scholar
  28. 28.
    Song TK, Harris EJ Jr, Raghavan S, Norton JA (2009) Major blood vessel reconstruction during sarcoma surgery. Arch Surg 144:817–822CrossRefPubMedGoogle Scholar
  29. 29.
    Wanebo HJ, Marcove RC (1981) Abdominal sacral resection of locally recurrent rectal cancer. Ann Surg 194:458–471CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Moriya Y1, Akasu T, Fujita S et al (2004) Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis Dis Colon Rectum 47:2047–2053 (discussion 2053-2054)CrossRefPubMedGoogle Scholar
  31. 31.
    Bhangu A, Brown G, Akmal M et al (2012) Outcome of abdominosacral resection for locally advanced primary and recurrent rectal cancer. Br J Surg 99:1453–1461CrossRefPubMedGoogle Scholar
  32. 32.
    Milne T, Solomon MJ, Lee P et al (2013) Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg 258:1007–1013CrossRefPubMedGoogle Scholar
  33. 33.
    Ramamurthy R, Bose JC, Muthusamy V et al (2009) Staged sacrectomy – an adaptive approach. J Neurosurg Spine 11:285–294CrossRefPubMedGoogle Scholar
  34. 34.
    Sagar PM, Gonsalves S, Heath RM et al (2009) Composite abdominosacral resection for recurrent rectal cancer. Br J Surg 96:191–196CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Andrea Belli
  • Francesco Bianco
  • Silvia De Franciscis
  • Giovanni M. Romano
    • 1
    Email author
  1. 1.Gastrointestinal Surgical Oncology Department of Abdominal OncologyIstituto Nazionale Tumori - IRCCS Fondazione G. PascaleNaplesItaly

Personalised recommendations