Abstract
Despite significant progress in the treatment of rectal cancer, local recurrence remains a difficult problem,1 resulting in considerable morbidity and high cancer-related mortality. Prevention of local recurrence should therefore be the chief goal of the operating surgeon and multidisciplinary management team. However, some patients are potential candidates for curative re-resection and therapy. This chapter addresses the issues involved in surgical management of patients with locally recurrent rectal cancer.
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References
Heriot AG, Tekkis PP, Darzi A, Mackay J. Surgery for local recurrence of rectal cancer. Colorectal Dis. 2006;8(9):733–47.
Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2007;14(2):447–54.
Rich TA, Ota D, Rosenthal SA, et al. Management of resectable rectal cancer. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215 Suppl:1473–80.
Kapiteijn E, Marijnen CA, Colenbrander AC, et al. Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the west Netherlands. Eur J Surg Oncol. 1998;24(6):528–35.
Kapiteijn E, van de Velde CJ. The role of total mesorectal excision in the management of rectal cancer. Surg Clin North Am. 2002;82(5):995–1007.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341(8843):457–60.
Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000;356(9224):93–6.
Hahnloser D, Nelson H, Gunderson LL, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg. 2003;237(4):502–8.
Wibe A, Moller B, Norstein J, et al. A national strategic change in treatment policy for rectal cancer–implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum. 2002;45(7):857–66.
Holm T, Cedermark B, Rutqvist LE. Local recurrence of rectal adenocarcinoma after “curative” surgery with and without preoperative radiotherapy. Br J Surg. 1994;81(3):452–5.
Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following "curative surgery" for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer. 1974;34(4):1278–92.
Shoup M, Guillem JG, Alektiar KM, et al. Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy. Dis Colon Rectum. 2002;45(5):585–92.
Wanebo HJ, Antoniuk P, Koness RJ, et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum. 1999;42(11):1438–48.
Wong CS, Cummings BJ, Brierley JD, et al. Treatment of locally recurrent rectal carcinoma–results and prognostic factors. Int J Radiat Oncol Biol Phys. 1998;40(2):427–35.
Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg. 1986;73(5):342–4.
Rominger CJ, Gunderson LL, Gelber RD, Conner N. Radiation therapy alone or in combination with chemotherapy in the treatment of residual or inoperable carcinoma of the rectum and rectosigmoid or pelvic recurrence following colorectal surgery. Radiation Therapy Oncology Group study (76–16). Am J Clin Oncol. 1985;8(2):118–27.
McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg. 1985;72(1):34–7.
Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984;53(6):1354–62.
Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983;52(7):1317–29.
Minsky BD, Cohen AM, Fass D, Enker WE, Sigurdson E, Harrison L. Intraoperative brachytherapy alone for incomplete resected recurrent rectal cancer. Radiother Oncol. 1991;21(2):115–20.
Alektiar KM, Zelefsky MJ, Paty PB, et al. High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2000;48(1):219–26.
Hahnloser D, Haddock MG, Nelson H. Intraoperative radiotherapy in the multimodality approach to colorectal cancer. Surg Oncol Clin North Am. 2003;12(4):993–1013, ix.
Mannaerts GH, Martijn H, Crommelin MA, et al. Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys. 1999;45(2):297–308.
Mannaerts GH, Rutten HJ, Martijn H, Hanssens PE, Wiggers T. Comparison of intraoperative radiation therapy-containing multimodality treatment with historical treatment modalities for locally recurrent rectal cancer. Dis Colon Rectum. 2001;44(12):1749–58.
Calvo FA, Meirino RM, Orecchia R. intraoperative radiation therapy part 2. Clinical results. Crit Rev Oncol Hematol. 2006;59(2):116–27.
Bussieres E, Gilly FN, Rouanet P, et al. Recurrences of rectal cancers: results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative Radiation Therapy. Int J Radiat Oncol Biol Phys. 1996;34(1):49–56.
Meguerditchian AN, Bairati I, Lagace R, Harel F, Kibrite A. Prognostic significance of lymphovascular invasion in surgically cured rectal carcinoma. Am J Surg. 2005;189(6):707–13.
Heys SD, Sherif A, Bagley JS, Brittenden J, Smart C, Eremin O. Prognostic factors and survival of patients aged less than 45 years with colorectal cancer. Br J Surg. 1994;81(5):685–8.
Ogiwara H, Nakamura T, Baba S. Variables related to risk of recurrence in rectal cancer without lymph node metastasis. Ann Surg Oncol. 1994;1(2):99–104.
Mulcahy HE, Toner M, Patchett SE, Daly L, O'Donoghue DP. Identifying stage B colorectal cancer patients at high risk of tumor recurrence and death. Dis Colon Rectum. 1997;40(3):326–31.
Blumberg D, Paty PB, Picon AI, et al. Stage I rectal cancer: identification of high-risk patients. J Am Coll Surg. 1998;186(5):574–9; discussion 579–80.
Mulcahy HE, Skelly MM, Husain A, O'Donoghue DP. Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg. 1996;83(1):46–50.
Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2(8514):996–9.
Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344(8924):707–11.
Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89(3):327–34.
Andreola S, Leo E, Belli F, et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis. Dis Colon Rectum. 1997;40(1):25–9.
Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer. 1995;76(3):388–92.
Kwok SP, Lau WY, Leung KL, Liew CT, Li AK. Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. Br J Surg. 1996;83(7):969–72.
Guillem JG, Chessin DB, Shia J, et al. A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation. Ann Surg. 2007;245(1):88–93.
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82.
Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet. 2001;358(9290):1291–304.
Heriot AG, Kumar D. Adjuvant therapy for resectable rectal and colonic cancer. Br J Surg. 1998;85(3):300–9.
Glimelius B, Gronberg H, Jarhult J, Wallgren A, Cavallin-Stahl E. A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol (Stockholm, Sweden). 2003;42(5–6):476–92.
Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAMA. 2000;284(8):1008–15.
Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355(11):1114–23.
Moore HG, Shoup M, Riedel E, et al. Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum. 2004;47(10):1599–606.
Ward BA, Miller DL, Frank JA, et al. Prospective evaluation of hepatic imaging studies in the detection of colorectal metastases: correlation with surgical findings. Surgery. 1989;105(2 Pt 1):180–7.
Barkin JS, Cohen ME, Flaxman M, et al. Value of a routine follow-up endoscopy program for the detection of recurrent colorectal carcinoma. Am J Gastroenterol. 1988;83(12):1355–60.
Moss AA, Thoeni RF, Schnyder P, Margulis AR. Value of computed tomography in the detection and staging of recurrent rectal carcinomas. J Comp Asst Tomogr. 1981;5(6):870–4.
Adalsteinsson B, Glimelius B, Graffman S, Hemmingsson A, Pahlman L, Rimsten A. Computed tomography of recurrent rectal carcinoma. Acta Radiol: Diagn. 1981;22(6):669–72.
Chen YM, Ott DJ, Wolfman NT, Gelfand DW, Karsteadt N, Bechtold RE. Recurrent colorectal carcinoma: evaluation with barium enema examination and CT. Radiology. 1987;163(2):307–10.
Grabbe E, Winkler R. Local recurrence after sphincter-saving resection for rectal and rectosigmoid carcinoma. Value of various diagnostic methods. Radiology. 1985;155(2):305–10.
Farouk R, Duthie GS, Lee PW, Monson JR. Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum. 1998;41(7):888–91.
Messiou C, Chalmers A, Boyle K, Sagar P. Surgery for recurrent rectal carcinoma: The role of preoperative magnetic resonance imaging. Clin Radiol. 2006;61(3):250–8.
Pema PJ, Bennett WF, Bova JG, Warman P. CT vs MRI in diagnosis of recurrent rectosigmoid carcinoma. J Comp Asst Tomogr. 1994;18(2):256–61.
Even-Sapir E, Parag Y, Lerman H, et al. Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology. 2004;232(3):815–22.
Morken JJ, Baxter NN, Madoff RD, Finne CO, 3rd. Endorectal ultrasound-directed biopsy: a useful technique to detect local recurrence of rectal cancer. Int J Colorectal Dis. 2006;21(3):258–64.
Rotondano G, Esposito P, Pellecchia L, Novi A, Romano G. Early detection of locally recurrent rectal cancer by endosonography. Br J Radiol. 1997;70(834):567–71.
de Anda EH, Lee SH, Finne CO, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery. Dis Colon Rectum. 2004;47(6):818–24.
Lopez-Kostner F, Fazio VW, Vignali A, Rybicki LA, Lavery IC. Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum. 2001;44(2):173–8.
Garcia-Aguilar J, Cromwell JW, Marra C, Lee SH, Madoff RD, Rothenberger DA. Treatment of locally recurrent rectal cancer. Dis Colon Rectum. 2001;44(12):1743–8.
Schneebaum S, Arnold MW, Young D, et al. Role of carcinoembryonic antigen in predicting resectability of recurrent colorectal cancer. Dis Colon Rectum. 1993;36(9):810–5.
Lev-Chelouche D, Keidar A, Rub R, Matzkin H, Gutman M. Hydronephrosis associated with colorectal carcinoma: treatment and outcome. Eur J Surg Oncol. 2001;27(5):482–6.
Suzuki K, Dozois RR, Devine RM, et al. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum. 1996;39(7):730–6.
Guillem JG, Ruo, L. Strategies in operative therapy for locally recurrent rectal cancer. Semin Colon Rectal Surg. 1998;9(4):259–68.
Bedrosian I, Giacco G, Pederson L, et al. Outcome after curative resection for locally recurrent rectal cancer. Dis Colon Rectum. 2006;49(2):175–82.
Miner TJ, Jaques DP, Paty PB, Guillem JG, Wong WD. Symptom control in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2003;10(1):72–9.
Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum. 2003;46(12):1619–25.
Salo JC, Paty PB, Guillem J, Minsky BD, Harrison LB, Cohen AM. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol. 1999;6(2):171–7.
Melton GB, Paty PB, Boland PJ, et al. Sacral resection for recurrent rectal cancer: analysis of morbidity and treatment results. Dis Colon Rectum. 2006;49(8):1099–107.
Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer. Surg Oncol Clin North Am. 2005;14(2):225–38.
Mannaerts GH, Rutten HJ, Martijn H, Groen GJ, Hanssens PE, Wiggers T. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum. 2001;44(6):806–14.
Harrison LB, Minsky BD, Enker WE, et al. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1998;42(2):325–30.
Noyes RD, Weiss SM, Krall JM, et al. Surgical complications of intraoperative radiation therapy: the Radiation Therapy Oncology Group experience. J Surg Oncol. 1992;50(4):209–15.
Gunderson LL, Nelson H, Martenson JA, et al. Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Dis Colon Rectum. 1996;39(12):1379–95.
Wallace HJ, 3rd, Willett CG, Shellito PC, Coen JJ, Hoover HC, Jr. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. J Surg Oncol. 1995;60(2):122–7.
Abuchaibe O, Calvo FA, Azinovic I, Aristu J, Pardo F, Alvarez-Cienfuegos J. Intraoperative radiotherapy in locally advanced recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 1993;26(5):859–67.
Rey JF, Romanczyk T, Greff M. Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients. Endoscopy. 1995;27(7):501–4.
Hünerbein M, Krause M, Moesta KT, Rau B, Schlag PM. Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery. 2005;137(1):42–7.
Repici A, Pagano N, Hervoso CM, et al. Metal stents for malignant colorectal obstruction. Minim Invasive Ther Allied Technol. 2006;15(6):331–8.
Tomiki Y, Watanabe T, Ishibiki Y, et al. Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction. Surg Endosc. 2004;18(11):1572–7.
Spinelli P, Mancini A. Use of self-expanding metal stents for palliation of rectosigmoid cancer. Gastrointest Endosc. 2001;53(2):203–6.
Lau PW, Lorentz TG. Results of surgery for malignant bowel obstruction in advanced, unresectable, recurrent colorectal cancer. Dis Colon Rectum. 1993;36(1):61–4.
Milsom JW, Kim SH, Hammerhofer KA, Fazio VW. Laparoscopic colorectal cancer surgery for palliation. Dis Colon Rectum. 2000;43(11):1512–6.
Kimmey MB. Endoscopic methods (other than stents) for palliation of rectal carcinoma. J Gastrointest Surg. 2004;8(3):270–3.
Rao VS, Al-Mukhtar A, Rayan F, Stojkovic S, Moore PJ, Ahmad SM. Endoscopic laser ablation of advanced rectal carcinoma–a DGH experience. Colorectal Dis. 2005;7(1):58–60.
Kiran RP, Pokala N, Burgess P. Use of laser for rectal lesions in poor-risk patients. Am J Surg. 2004;188(6):708–13.
Fenger C FM, Marti MC, Parc R. WHO classification of tumors. Pathology and genetics of tumors of the digestive system. In: Hamilton SR, Aaltonen LA, eds. Tumors of the anal canal. Lyon, France; International Agency for Research on Cancer (IARC); 2002:146–55.
Green FL PD, Fleming ID, et al. American Joint Committee on Cancer 6th ed; New York: Springer-Verlag; 2002:139–44, 231–7.
Nigro N, Vaitkevicius, VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum. 1974;17:354–6.
Clark MA, Hartley A, Geh JI. Cancer of the anal canal. Lancet Oncol. 2004;5(3):149–57.
Ferenschild FT, Vermaas M, Hofer SO, Verhoef C, Eggermont AM, de Wilt JH. Salvage abdominoperineal resection and perineal wound healing in local recurrent or persistent anal cancer. World J Surg. 2005;29(11):1452–7.
Bai YK, Cao WL, Gao JD, Liang J, Shao YF. Surgical salvage therapy of anal cancer. World J Gastroenterol. 2004;10(3):424–6.
van der Wal BC, Cleffken BI, Gulec B, Kaufman HS, Choti MA. Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy. J Gastrointest Surg. 2001;5(4):383–7.
Zelnick RS, Haas PA, Ajlouni M, Szilagyi E, Fox TA, Jr. Results of abdominoperineal resections for failures after combination chemotherapy and radiation therapy for anal canal cancers. Dis Colon Rectum. 1992;35(6):574–7; discussion 577–8.
Akbari RP, Paty PB, Guillem JG, et al. Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy. Dis Colon Rectum. 2004;47(7):1136–44.
Longo WE, Vernava AM, 3rd, Wade TP, Coplin MA, Virgo KS, Johnson FE. Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy. Ann Surg. 1994;220(1):40–9.
Nilsson PJ, Svensson C, Goldman S, Glimelius B. Salvage abdominoperineal resection in anal epidermoid cancer. Br J Surg. 2002;89(11):1425–9.
Allal AS, Laurencet FM, Reymond MA, Kurtz JM, Marti MC. Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment. Cancer. 1999;86(3):405–9.
Pocard M, Tiret E, Nugent K, Dehni N, Parc R. Results of salvage abdominoperineal resection for anal cancer after radiotherapy. Dis Colon Rectum. 1998;41(12):1488–93.
Ellenhorn JD, Enker WE, Quan SH. Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol. 1994;1(2):105–10.
Papaconstantinou HT, Bullard KM, Rothenberger DA, Madoff RD. Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity. Colorectal Dis. 2006;8(2):124–9.
Tei TM, Stolzenburg T, Buntzen S, Laurberg S, Kjeldsen H. Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery. Br J Surg. 2003;90(5):575–80.
Greenall MJ, Magill GB, Quan SH, DeCosse JJ. Recurrent epidermoid cancer of the anus. Cancer. 1986;57(7):1437–41.
Bulow S, Christensen IJ, Harling H, Kronborg O, Fenger C, Nielsen HJ. Recurrence and survival after mesorectal excision for rectal cancer. Br J Surg. 2003;90(8):974–80.
Nesbakken A, Nygqaard K, Westerheim O, Mala T, Lunde OC. Local recurrence after mesorectal excision for rectal cancer. Eur J Surg Oncol. 2002;28(2):126–34.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg. 1998;133(8):894–9.
Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995;181(4):335–46.
Valentini V, Morganti AG, De Franco A, et al. Chemoradiation with or without intraoperative radiation therapy in patients with locally recurrent rectal carcinoma: prognostic factors and long term outcome. Cancer. 1999;86(12):2612–24.
Wiig JN, Poulsen JP, Larsen S, Braendengen M, Waehre H, Giercksky KE. Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer. Eur J Surg. 2002;168(1):42–8.
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Poggio, J.L., Wong, W.D. (2009). Introduction to Reoperative Pelvic Surgery for Rectal Cancer. In: Billingham, R., Kobashi, K., Peters, W. (eds) Reoperative Pelvic Surgery. Springer, New York, NY. https://doi.org/10.1007/b14187_10
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