Local recurrence after rectal cancer surgery is an important clinical problem.
Dr Wiig and colleagues from Norway assessed 150 patients with local recurrence after rectal or rectosigmoid cancer who underwent surgery after preoperative irradiation.
The research team found that the overall 5-year survival was 27%.
|Survival was 52% with a R0-resection|
The team found corresponding survival and local recurrence rates were 52% and 27%, respectively for R0-stage.
For R1 stage, survival was 14%, and local recurrence rates were 63%.
R2-resected patients survived 4 years.
The team found a normal pretreatment CEA level was significantly associated with increased survival.
However, normalization following preoperative therapy was not associated with an improvement in prognosis.
The researchers observed that survival and local recurrence were also significantly influenced by the type of primary operation.
Several factors were significant for the prediction of an R0-resection in univariate analysis.
The team noted that only CEA, and symptoms at the time of recurrence predicted an R0-resection in multivariate analysis.
A long latency time to recurrence did not significantly influence prognosis.
Dr Wiig's team concluded, "Preoperative irradiation and surgery can result in an R0-resection and a long survival in patients with recurrence after initial treatment for rectal or rectosigmoid cancer."
"Patients with an R1-resection can also benefit from surgery since a substantial number will die without further local recurrence."
"An R0-resection is the main prognostic factor followed by CEA level, sex and type of primary operation."
"Normalization of CEA after preoperative treatment is not of prognostic significance."
"The value of the Norwegian follow-up regimen is questioned."