TY - JOUR
T1 - Is en-bloc resection of locally recurrent rectal carcinoma involving the urinary tract indicated?
AU - Stocchi, Luca
AU - Nelson, Heidi
AU - Sargent, Daniel J.
AU - Engen, Donald E.
AU - Haddock, Michael G.
PY - 2006/5
Y1 - 2006/5
N2 - Background: This study investigated morbidity, mortality, and long-term survival after multimodality management of locally recurrent rectal carcinoma involving the urinary tract. Methods: A total of 82 patients (63 males) were identified during 1987 to 2000. Data sources were a prospectively collected database of intraoperative radiotherapy, institutional tumor registry, and chart review. The median follow-up was 3.3 years and lasted until death or for at least 2 years on all patients. Results: A total of 20 (24%) of 82 patients had resection of urogenital tract structures without reconstruction. Sixty-two patients (76%) underwent reconstruction with ileal conduit (43%), ureteroneocystostomy (15%), or miscellaneous (18%). The mean number of fixation sites was 2.8 (SD, 1.5), and the mean number of organs at least partially resected was 2.6 (SD, 1.3). Eighty percent of patients underwent intraoperative radiotherapy among adjuvant treatments. Postoperative mortality was 2% (2 of 82), and morbidity was 39% (32 of 82), most frequently consisting of neuropathy and urinary leak (6% each). The overall 1-, 3-, and 5-year survival rates were 82%, 45%, and 19%, respectively. The median survival was 2.6 years. The number of sites involved was the only survival predictor at multivariate analysis (P < .001). Conclusions: A multimodality approach for locally recurrent rectal carcinoma involving the urinary tract carries acceptable morbidity, mortality, and potential for long-term survival. The number of fixation sites correlates with a poorer prognosis.
AB - Background: This study investigated morbidity, mortality, and long-term survival after multimodality management of locally recurrent rectal carcinoma involving the urinary tract. Methods: A total of 82 patients (63 males) were identified during 1987 to 2000. Data sources were a prospectively collected database of intraoperative radiotherapy, institutional tumor registry, and chart review. The median follow-up was 3.3 years and lasted until death or for at least 2 years on all patients. Results: A total of 20 (24%) of 82 patients had resection of urogenital tract structures without reconstruction. Sixty-two patients (76%) underwent reconstruction with ileal conduit (43%), ureteroneocystostomy (15%), or miscellaneous (18%). The mean number of fixation sites was 2.8 (SD, 1.5), and the mean number of organs at least partially resected was 2.6 (SD, 1.3). Eighty percent of patients underwent intraoperative radiotherapy among adjuvant treatments. Postoperative mortality was 2% (2 of 82), and morbidity was 39% (32 of 82), most frequently consisting of neuropathy and urinary leak (6% each). The overall 1-, 3-, and 5-year survival rates were 82%, 45%, and 19%, respectively. The median survival was 2.6 years. The number of sites involved was the only survival predictor at multivariate analysis (P < .001). Conclusions: A multimodality approach for locally recurrent rectal carcinoma involving the urinary tract carries acceptable morbidity, mortality, and potential for long-term survival. The number of fixation sites correlates with a poorer prognosis.
KW - Ileal conduit
KW - Local recurrence
KW - Pelvic exenteration
KW - Rectal carcinoma
KW - Ureteroneocystostomy
KW - Urinary diversion
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U2 - 10.1245/ASO.2006.03.073
DO - 10.1245/ASO.2006.03.073
M3 - Review article
C2 - 16523359
AN - SCOPUS:33645882540
SN - 1068-9265
VL - 13
SP - 740
EP - 744
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -