Prognostic factors in surgery for local recurrence of rectal cancer.

Fifty-five patients had resection of locally recurrent rectal cancer. Fourteen patients (25 per cent) had distant metastases, which were resected concurrently in six (11 per cent). Thirty-three patients (60 per cent) had preoperative (one patient) or postoperative (32) external beam radiotherapy (45-60 Gy). The 5-year survival rate was 18 per cent with a median survival of 24 months. The median symptom-free interval was 24 months. At a median follow-up of 28 months 53 per cent of patients had a second local recurrence and 24 per cent metastases only. Treatment complications occurred in 12 patients (22 per cent), three (5 per cent) of whom died 3-10 months after operation. Variables that were significantly related with longer survival and palliation were the radical nature of the operation, the absence of severe symptoms (such as pain, obstruction or sepsis), a recurrent tumour diameter of less than 5 cm measured on the resected specimen and a normal carcinoembryonic antigen level after reoperation. A Cox regression model showed that recurrent tumour diameter was the only independent prognostic variable. Surgery for local recurrence achieved local control in 47 per cent of patients with a low morbidity and mortality rate.