Outcomes of salvage surgery for cure in patients with locally recurrent disease after local excision of rectal cancer

Jai Bikhchandani, Gabie K. Ong, Eric Dozois, Kellie L. Mathis

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)283-287
Number of pages5
JournalDiseases of the Colon and Rectum
Volume58
Issue number3
DOIs
StatePublished - Jan 1 2015

Fingerprint

Rectal Neoplasms
Recurrence
Survival
Selection Bias
Tertiary Care Centers
Disease-Free Survival
Cohort Studies
Radiotherapy
Referral and Consultation
Lymph Nodes

Keywords

  • Local excision
  • Local recurrence
  • Rectal cancer
  • Salvage surgery

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Outcomes of salvage surgery for cure in patients with locally recurrent disease after local excision of rectal cancer. / Bikhchandani, Jai; Ong, Gabie K.; Dozois, Eric; Mathis, Kellie L.

In: Diseases of the Colon and Rectum, Vol. 58, No. 3, 01.01.2015, p. 283-287.

Research output: Contribution to journalArticle

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abstract = "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.",
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