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. 1987 May;205(5):482–495. doi: 10.1097/00000658-198705000-00006

Pelvic recurrence of rectal cancer. Options for curative resection.

H J Wanebo, D L Gaker, R Whitehill, R F Morgan, W C Constable
PMCID: PMC1493032  PMID: 2437869

Abstract

Pelvic recurrence is an ominous event after curative resection of rectal cancer and is rarely amenable to re-resection by conventional methods. A method to permit a composite resection of these using the abdominal sacral approach has been described previously. This report updates that experience with resection of pelvic recurrence of rectal cancer in 28 patients. Of these, 24 were done with curative intent, and four were done for palliation (mainly for infected or fungating tumor). All patients had extensive preoperative evaluation by clinical and radiologic tests, and most patients had a long free interval period of approximately 18 months, after their primary resection. Although 47 patients had exploratory surgery, only 29 had local disease amenable to resection and four had palliative resections. About half the patients had had an abdominoperineal resection, half had had an anterior resection, and one third had had previous efforts to resect the recurrence. All but one patient had been irradiated with 3000-11,000 cGy. All but two patients (of the 24 curative efforts) required a formal abdominosacral resection (through S1-2 in 12, S2-3 in 9, and S4-5 in 1). Over half the patients also required a bladder resection. There were three operative deaths (12%); one patient had a cardiac death immediately after operation and two were septic deaths at 35 and 60 days. The survivors generally had relief of sacral root pain and good motor function; most of those previously employed could return to work. The actuarial 5-year survival rate is 25% and median survival is 36 months. Long-term survival over 48 months was recorded in five of 21 surgical survivors (23.8%). Survival in a historic comparative group of 30 patients treated for local recurrence only (mainly by radiation) was 15 months median, and at 5 years the survival rate was 3% (p less than 0.001). In conclusion, selected patients with pelvic recurrence of rectal cancer may be retrieved by and returned to functional life with the composite abdominosacral resection.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BACON H. E., BERKLEY J. L. The rationale of re-resection for recurrent cancer of the colon and rectum. Dis Colon Rectum. 1959 Nov-Dec;2:549–554. doi: 10.1007/BF02617007. [DOI] [PubMed] [Google Scholar]
  2. Beart R. W., Jr, Metzger P. P., O'Connell M. J., Schutt A. J. Postoperative screening of patients with carcinoma of the colon. Dis Colon Rectum. 1981 Nov-Dec;24(8):585–588. doi: 10.1007/BF02605750. [DOI] [PubMed] [Google Scholar]
  3. Cass A. W., Million R. R., Pfaff W. W. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer. 1976 Jun;37(6):2861–2865. doi: 10.1002/1097-0142(197606)37:6<2861::aid-cncr2820370643>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  4. Cohen A. M., Wood W. C., Gunderson L. L., Shinnar M. Pathological studies in rectal cancer. Cancer. 1980 Jun 15;45(12):2965–2968. doi: 10.1002/1097-0142(19800615)45:12<2965::aid-cncr2820451213>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  5. Fritsch A., Seidl W., Walzel C., Moser K., Schiessel R. Palliative and adjunctive measures in rectal cancer. World J Surg. 1982 Sep;6(5):569–577. doi: 10.1007/BF01657871. [DOI] [PubMed] [Google Scholar]
  6. GEHAN E. A. A GENERALIZED WILCOXON TEST FOR COMPARING ARBITRARILY SINGLY-CENSORED SAMPLES. Biometrika. 1965 Jun;52:203–223. [PubMed] [Google Scholar]
  7. Gunderson L. L., Sosin H. Areas of failure found at reoperation (second or symptomatic look) following "curative surgery" for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer. 1974 Oct;34(4):1278–1292. doi: 10.1002/1097-0142(197410)34:4<1278::aid-cncr2820340440>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  8. Hickey R. C., Romsdahl M. M., Johnson D. E., Wallace S., Mavligit G. M., Leavens M. E., Borgelt B. Recurrent cancer and metastases. World J Surg. 1982 Sep;6(5):585–595. doi: 10.1007/BF01657873. [DOI] [PubMed] [Google Scholar]
  9. Martin E. W., Jr, Minton J. P., Carey L. C. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg. 1985 Sep;202(3):310–317. doi: 10.1097/00000658-198509000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Mendenhall W. M., Million R. R., Pfaff W. W. Patterns of recurrence in adenocarcinoma of the rectum and rectosigmoid treated with surgery alone: implications in treatment planning with adjuvant radiation therapy. Int J Radiat Oncol Biol Phys. 1983 Jul;9(7):977–985. doi: 10.1016/0360-3016(83)90384-x. [DOI] [PubMed] [Google Scholar]
  11. Moertel C. G., Schutt A. J., Go V. L. Carcinoembryonic antigen test for recurrent colorectal carcinoma. Inadequacy for early detection. JAMA. 1978 Mar 13;239(11):1065–1066. [PubMed] [Google Scholar]
  12. Olson R. M., Perencevich N. P., Malcolm A. W., Chaffey J. T., Wilson R. E. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer. 1980 Jun 15;45(12):2969–2974. doi: 10.1002/1097-0142(19800615)45:12<2969::aid-cncr2820451214>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  13. Pilipshen S. J., Heilweil M., Quan S. H., Sternberg S. S., Enker W. E. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984 Mar 15;53(6):1354–1362. doi: 10.1002/1097-0142(19840315)53:6<1354::aid-cncr2820530623>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  14. Unger S. W., Wanebo H. J. Colonoscopy: an essential monitoring technique after resection of colorectal cancer. Am J Surg. 1983 Jan;145(1):71–76. doi: 10.1016/0002-9610(83)90169-1. [DOI] [PubMed] [Google Scholar]
  15. Vassilopoulos P. P., Yoon J. M., Ledesma E. J., Mittelman A. Treatment of recurrence of adenocarcinoma of the colon and rectum at the anastomotic site. Surg Gynecol Obstet. 1981 Jun;152(6):777–780. [PubMed] [Google Scholar]
  16. WANGENSTEEN O. H., LEWIS F. J., ARHELGER S. W., MULLER J. J., MACLEAN L. D. An interim report upon the second look procedure for cancer of the stomach, colon, and rectum and for limited intraperitoneal carcinosis. Surg Gynecol Obstet. 1954 Sep;99(3):257–267. [PubMed] [Google Scholar]
  17. Wanebo H. J., Marcove R. C. Abdominal sacral resection of locally recurrent rectal cancer. Ann Surg. 1981 Oct;194(4):458–471. doi: 10.1097/00000658-198110000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Welch J. P., Donaldson G. A. Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg. 1978 Apr;135(4):505–511. doi: 10.1016/0002-9610(78)90028-4. [DOI] [PubMed] [Google Scholar]

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