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Operative vs nonoperative management of recurrent rectal cancer

The latest issue of Colorectal Disease compares long-term survival outcome of operative vs nonoperative management of recurrent rectal cancer.

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Complete surgical resection is considered the best treatment for recurrent rectal cancer.

Dr Bhangu and colleagues compared survival outcomes from operative and nonoperative patients presenting with recurrent rectal cancer.

The team reported that patients with recurrent rectal cancer whose management was discussed by a tertiary referral specialist multidisciplinary team between 2007 and 2011 were identified from a prospectively maintained database.

The primary end-point was 3-year overall survival.

The doctors assessed that of 127 patients with recurrent rectal cancer, it was isolated to the pelvis in 105, and associated with distant disease at presentation in 22.

From the time of primary surgery to first recurrence, 1-, 3-, 5- and 10-year local recurrence rates were 22%, 72%, 85% and 96%, respectively.

3-year overall survival rates were 69% for R0
Colorectal Disease

The researchers noted that the number of operated patients available at 1, 2 and 3 years’ follow-up was 53, 34 and 23, respectively.

Of 70 patients who underwent pelvic resection for recurrence, 64% received R0, 20% received R1, and 16% received R2 resections.

The team of doctors found that 3-year overall survival rates were 69%, 56% and 20% for R0, R1, and R2, respectively.

There was no significant difference in survival between R2 resection, and those managed nonoperatively.

The researchers reported that those undergoing surgery for pelvic recurrence affecting one or more compartments had a worse prognosis than those with single-compartment involvement.

The team reported that 3-year local recurrence-free survival was 80% with R0 resection vs 60% with R1 resection.

Dr Bhangu's team concluded, "Most recurrences occur within 5 years of primary surgery, although some occur up to 10 years later."

"R0 resection is the treatment of choice."

"There was no survival benefit of R2 resection over nonresected recurrences."

Colorectal Dis 2013: 15(2): 156-163
21 February 2013

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