J A W Hagemans1, J M van Rees2, W J Alberda2, J Rothbarth2, J J M E Nuyttens3, E van Meerten4, C Verhoef2, J W A Burger5. 1. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: j.hagemans@erasmusmc.nl. 2. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 3. Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 4. Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 5. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
Abstract
INTRODUCTION: The majority of patients with locally recurrent rectal cancer (LRRC) present with extensive metastatic disease or an unresectable recurrence, and will be treated palliatively. Only a minority of patients will be eligible for potential cure by surgical treatment. The aim of this study is to evaluate the long-term outcome of surgical treatment and non-surgical treatment of patients with LRRC. METHODS: All patients with LRRC referred to our tertiary institute between 2000 and 2015 were retrospectively analysed. Patients were discussed in a multidisciplinary tumour board (MDT) and eventually received curative surgical or non-surgical treatment. Overall survival (OS) was compared by resection margin status and non-surgical treatment. RESULTS: A total of 447 patients were discussed in our MDT of which 193 patients underwent surgical treatment and 254 patients received non-surgical treatment. Surgically treated patients were significantly younger, received less neoadjuvant therapy for the primary tumour, had less metastasis at diagnosis and more central recurrences. The 5-year OS was 51% for R0-resections and 34% for R1-resections. Although numbers with R2-resections were too small to implicate prognostic significance, there was no difference in 5-year OS between R2-resections and non-surgical treatment (10% vs. 4%, p = 0.282). In a subgroup analysis the OS of R2-patients was even poorer compared to optimal palliative treated patients with combined chemotherapy and radiotherapy (22 vs 29 months, p = 0.413). CONCLUSION: R2-resections do not result in a survival benefit compared to non-surgical treatment in this non-randomized series. Patients with a high chance on a R2-resection could be offered non-surgical treatment, without local resection.
INTRODUCTION: The majority of patients with locally recurrent rectal cancer (LRRC) present with extensive metastatic disease or an unresectable recurrence, and will be treated palliatively. Only a minority of patients will be eligible for potential cure by surgical treatment. The aim of this study is to evaluate the long-term outcome of surgical treatment and non-surgical treatment of patients with LRRC. METHODS: All patients with LRRC referred to our tertiary institute between 2000 and 2015 were retrospectively analysed. Patients were discussed in a multidisciplinary tumour board (MDT) and eventually received curative surgical or non-surgical treatment. Overall survival (OS) was compared by resection margin status and non-surgical treatment. RESULTS: A total of 447 patients were discussed in our MDT of which 193 patients underwent surgical treatment and 254 patients received non-surgical treatment. Surgically treated patients were significantly younger, received less neoadjuvant therapy for the primary tumour, had less metastasis at diagnosis and more central recurrences. The 5-year OS was 51% for R0-resections and 34% for R1-resections. Although numbers with R2-resections were too small to implicate prognostic significance, there was no difference in 5-year OS between R2-resections and non-surgical treatment (10% vs. 4%, p = 0.282). In a subgroup analysis the OS of R2-patients was even poorer compared to optimal palliative treated patients with combined chemotherapy and radiotherapy (22 vs 29 months, p = 0.413). CONCLUSION: R2-resections do not result in a survival benefit compared to non-surgical treatment in this non-randomized series. Patients with a high chance on a R2-resection could be offered non-surgical treatment, without local resection.
Authors: Harald C Groen; Anne G den Hartog; Wouter J Heerink; Koert F D Kuhlmann; Niels F M Kok; Ruben van Veen; Marijn A J Hiep; Petur Snaebjornsson; Brechtje A Grotenhuis; Geerard L Beets; Arend G J Aalbers; Theo J M Ruers Journal: Life (Basel) Date: 2022-04-27
Authors: Rosa M Jimenez-Rodriguez; Jonathan B Yuval; Charles-Etienne Gabriel Sauve; Isaac Wasserman; Piyush Aggarwal; Paul B Romesser; Christopher H Crane; Rona Yaeger; Andrea Cercek; Jose G Guillem; Martin R Weiser; Iris H Wei; Maria Widmar; Garrett M Nash; Emmanouil P Pappou; Julio Garcia-Aguilar; Marc J Gollub; Philip B Paty; J Joshua Smith Journal: Int J Colorectal Dis Date: 2021-07-22 Impact factor: 2.796