Surgical treatment of recurrent locoregional rectal cancer
Ghouti, L.; Portier, G.; Kirzin, S.; Guimbaud, R.; Lazorthes, F.
Gastroenterologie Clinique et Biologique 31(1): 55-67
2007
ISSN/ISBN: 0399-8320 PMID: 17273131 Document Number: 606248
Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially if surgery is sub-optimal (without total excision of the mesorectum). In many cases, diagnosis of LR is made at a late stage because of the high rate of asymptomatic patients, 56% in the experience of the Mayo Clinic. MRI and PET-scan are most effective for assessing local and general extension, with a high diagnostic accuracy.Surgical treatment alone or with radiation (preoperative and/or intraoperative) is the only curative treatment of LR with RO resectability rates of 30% to 45%. Morbidity and mortality rates are high, especially for total exenteration and abdominosacral resection. After curative surgery, 5-year global survival is between 30% and 40%. Palliative resection of macroscopic residues is not recommended. Careful patient selection for curative surgery is the best way to optimize treatment in these cases.