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.
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.
Authors: Sun Min Park; Bong-Hyeon Kye; Min Ki Kim; Heba E Jalloun; Hyeon-Min Cho; In Kyu Lee Journal: Int J Colorectal Dis Date: 2018-02-14 Impact factor: 2.571
Authors: J W A Leijtens; L J H Smits; T W A Koedam; R G Orsini; S M van Aalten; M Verseveld; P G Doornebosch; E J R de Graaf; J B Tuynman Journal: Tech Coloproctol Date: 2022-08-27 Impact factor: 3.699
Authors: Yunghuyn Hwang; Yong Sik Yoon; Jun Woo Bong; Hye Yun Choi; In Ho Song; Jong Lyul Lee; Chan Wook Kim; In Ja Park; Seok-Byung Lim; Chang Sik Yu; Jin Cheon Kim Journal: Ann Coloproctol Date: 2019-08-31
Authors: S E van Oostendorp; L J H Smits; Y Vroom; R Detering; M W Heymans; L M G Moons; P J Tanis; E J R de Graaf; C Cunningham; Q Denost; M Kusters; J B Tuynman Journal: Br J Surg Date: 2020-09-16 Impact factor: 6.939