Is curative resection and long-term survival possible for locally re-recurrent colorectal cancer in the pelvis?

BACKGROUND: A multimodality approach for locally recurrent colorectal cancer in the pelvis provides a significant survival advantage when negative margins are achieved. However, outcomes of surgical resection in patients who have locally re-recurrent disease in the pelvis are not well studied. Our aim was to assess the safety, feasibility of a negative margin resection, and survival outcomes in patients with pelvic locally re-recurrent colorectal cancer. DESIGN: A retrospective review identified 406 patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. Patients who had locally re-recurrent disease in the pelvis who underwent curative-intent resection were identified. RESULTS: Forty-seven patients (31 male) were identified. Median age was 57 years (range, 30-84 years). Median time to re-recurrence was 2.4 years (range, 0.5-5.6 years). Margin status following re-resection was R0 60%, R1 32%, and R2 8%. Nonbowel organs were resected en bloc in 81%, including 7 sacral resections. Intraoperative radiation was given to 77%. Morbidity occurred in 42%, with 6% requiring reoperation for complications. Thirty-day mortality was nil. Overall survival at 2 and 5 years was 83% and 33%. Disease-free survival at 2 and 5 years was 55% and 27%. Five-year survival for patients who had R0 and R1 resections was 37% and 42%, whereas no patients having an R2 resection survived beyond 2 years (p = 0.002). CONCLUSIONS: In highly selected patients with re-recurrent colorectal cancer in the pelvis, we found that surgery could be performed safely and that a curative (R0) resection was possible in more than 50%. Two- and 5-year survival rates are comparable to results seen when surgery is done for first-time recurrences.