The outcomes and patterns of treatment failure after surgery for locally recurrent rectal cancer

Harris, Craig A., Solomon, Michael J., Heriot, Alexander G., Sagar, Peter M., Tekkis, Paris P., Dixon, Liane, Pascoe, Rebecca, Dobbs, Bruce R., Frampton, Chris M., Harji, Deena P., Kontovounisios, Christos, Austin, Kirk K., Koh, Cherry E., Lee, Peter J., Lynch, Andrew C., Warrier, Satish K. and Frizelle, Frank A. (2015) The outcomes and patterns of treatment failure after surgery for locally recurrent rectal cancer. Annals of Surgery, . doi:10.1097/SLA.0000000000001524


Author Harris, Craig A.
Solomon, Michael J.
Heriot, Alexander G.
Sagar, Peter M.
Tekkis, Paris P.
Dixon, Liane
Pascoe, Rebecca
Dobbs, Bruce R.
Frampton, Chris M.
Harji, Deena P.
Kontovounisios, Christos
Austin, Kirk K.
Koh, Cherry E.
Lee, Peter J.
Lynch, Andrew C.
Warrier, Satish K.
Frizelle, Frank A.
Title The outcomes and patterns of treatment failure after surgery for locally recurrent rectal cancer
Journal name Annals of Surgery   Check publisher's open access policy
ISSN 0003-4932
1528-1140
Publication date 2015-12
Year available 2015
Sub-type Article (original research)
DOI 10.1097/SLA.0000000000001524
Open Access Status Not Open Access
Total pages 7
Place of publication Philadelphia, United States
Publisher Lippincott Williams & Wilkins
Collection year 2016
Language eng
Formatted abstract
Objective: To assess the outcomes and patterns of treatment failure of patients who underwent pelvic exenteration surgery for recurrent rectal cancer.

Background: Despite advances in the management of rectal cancer, local recurrence still occurs. For appropriately selected patients, pelvic exenteration surgery can achieve long-term disease control.

Methods: Prospectively maintained databases of 5 high volume institutions for pelvic exenteration surgery were reviewed and data combined. We assessed the combined endpoints of overall 5-year survival, cancer-specific 5-year mortality, local recurrence, and the development of metastatic disease.

Results: Five hundred thirty-three patients who had undergone surgery for locally recurrent rectal cancer were identified. Five-year cancer-specific survival for patients with a complete (R0) resection is 44%, which was achieved in 59% of patients. For those with R1 and R2 resections, the 5-year survival was 26% and 10%, respectively. Radical resection required sacrectomy in 170 patients (32%), and total cystectomy in 105 patients (20%). Treatment failure included local recurrence alone in 75 patients (14%) and systemic metastases with or without local recurrence in 226 patients (42%). Chemoradiotherapy before exenteration was associated with a significant (P < 0.05) improvement in overall 5-year cancer-specific survival for those patients with an R0 resection. Postoperative chemotherapy did not alter outcomes.

Conclusions: R0 resection of the pelvic recurrence is the most significant factor affecting overall and disease-free survival. The surgery is complex and often highly morbid, and where possible patients should be given perioperative chemoradiotherapy. Further investigations are required to determine the role of adjuvant chemotherapy.
Keyword Malignancy
Pelvic exenteration
Rectal cancer
Recurrent rectal cancer
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Sat, 09 Jan 2016, 14:12:22 EST by Craig Harris on behalf of Surgery - Mater Hospital