TY - JOUR
T1 - Outcomes of salvage surgery for cure in patients with locally recurrent disease after local excision of rectal cancer
AU - Bikhchandani, Jai
AU - Ong, Gabie K.
AU - Dozois, Eric J.
AU - Mathis, Kellie L.
N1 - Publisher Copyright:
© The ASCRS 2015.
PY - 2015
Y1 - 2015
N2 - BACKGROUND: Local excision for early rectal cancer has gained widespread interest. Currently available imaging modalities have low sensitivity to detect locoregional disease, which may result in understaging and a high risk of recurrence after local excision. OBJECTIVE: The purpose of this work was to study the morbidity, mortality, and long-term oncologic outcomes in a select cohort of patients undergoing salvage surgery for local recurrence after local excision of early rectal cancer. DESIGN: A retrospective review of patient charts was used to determine patterns of disease recurrence and outcomes as a single-institution case series. SETTINGS: The study was conducted at a tertiary care cancer center. PATIENTS: The study cohort included patients with early rectal cancer treated by local excision who then developed local recurrence for which a multimodal salvage surgery with curative intent was performed between 1997 and 2013 at our center. MAIN OUTCOME MEASURES: Log rank tests were used to measure overall and disease-free survival. RESULTS: Twenty-seven patients were identified, with a mean age of 66 ± 12 years. The median time to recurrence was 54 weeks (range, 7-326 weeks). Recurrent disease was luminal in 23 patients, regional (involving both mesorectal and pelvic lymph nodes) in 6 patients, and both luminal and nodal in 2 patients. For salvage surgery, neoadjuvant chemoradiation was used in 12 patients (44%), and radiation alone was used in 1 patient. Sphincter-preserving surgery was performed in 9 patients (33%). R0 resection was achieved in 25 patients (93%). Four patients received intraoperative radiation therapy. Five-year overall survival was 50% (95% CI, 30%-74%), and re-recurrence-free survival was 47% (95% CI, 25%-68%). LIMITATIONS: This study was limited by its retrospective nature, small patient cohort, referral bias, and selection bias. CONCLUSIONS: Even in highly selected patients who undergo surgery for local recurrence after transanal excision of early stage rectal cancer, oncologic outcomes are poor.
AB - BACKGROUND: Local excision for early rectal cancer has gained widespread interest. Currently available imaging modalities have low sensitivity to detect locoregional disease, which may result in understaging and a high risk of recurrence after local excision. OBJECTIVE: The purpose of this work was to study the morbidity, mortality, and long-term oncologic outcomes in a select cohort of patients undergoing salvage surgery for local recurrence after local excision of early rectal cancer. DESIGN: A retrospective review of patient charts was used to determine patterns of disease recurrence and outcomes as a single-institution case series. SETTINGS: The study was conducted at a tertiary care cancer center. PATIENTS: The study cohort included patients with early rectal cancer treated by local excision who then developed local recurrence for which a multimodal salvage surgery with curative intent was performed between 1997 and 2013 at our center. MAIN OUTCOME MEASURES: Log rank tests were used to measure overall and disease-free survival. RESULTS: Twenty-seven patients were identified, with a mean age of 66 ± 12 years. The median time to recurrence was 54 weeks (range, 7-326 weeks). Recurrent disease was luminal in 23 patients, regional (involving both mesorectal and pelvic lymph nodes) in 6 patients, and both luminal and nodal in 2 patients. For salvage surgery, neoadjuvant chemoradiation was used in 12 patients (44%), and radiation alone was used in 1 patient. Sphincter-preserving surgery was performed in 9 patients (33%). R0 resection was achieved in 25 patients (93%). Four patients received intraoperative radiation therapy. Five-year overall survival was 50% (95% CI, 30%-74%), and re-recurrence-free survival was 47% (95% CI, 25%-68%). LIMITATIONS: This study was limited by its retrospective nature, small patient cohort, referral bias, and selection bias. CONCLUSIONS: Even in highly selected patients who undergo surgery for local recurrence after transanal excision of early stage rectal cancer, oncologic outcomes are poor.
KW - Local excision
KW - Local recurrence
KW - Rectal cancer
KW - Salvage surgery
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U2 - 10.1097/DCR.0000000000000283
DO - 10.1097/DCR.0000000000000283
M3 - Article
C2 - 25664705
AN - SCOPUS:84928104254
SN - 0012-3706
VL - 58
SP - 283
EP - 287
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 3
ER -