Palliative surgery for locally recurrent colorectal cancer

Recurrent colorectal cancer carries a poor prognosis. Radical re-resection is the only chance for long-term survival but suitable candidates are few.

To determine the patterns of recurrence after potentially curative colorectal surgery and analyse the results of palliative surgery for patients with local recurrence.

Between May 1989 and May 1995, 1,287 case records of patients with colorectal carcinoma were entered into a customized computer database. Of these, 1,103 underwent potentially curative resections (Duke's stage A, B and C). At a median of 40 months (range 2-72) following surgery, 173 patients had recurrent disease detected (98 males; 75 females) at a median of 14 months (range 3-30) after the index surgery. Twelve percent had recurrent distal and locoregional disease while 6.8% had locoregional recurrent disease alone. Thirty-seven patients with locally recurrent disease underwent surgery. Of these, only 7 patients with local recurrences were suitable candidates for resections. The remaining 30 underwent palliative surgery for emergent indications of obstruction (28) and bleeding (2). The symptoms were palliated surgically by an entero-enterostomy (13), defunctioning stoma (12), lysis of adhesions (1), exploratory celiotomy (2) and formalin application (2). Seventeen patients are alive at follow-up. Twenty patients died at a median of 4 months after surgery (range 1-15). All patients had palliation of their symptoms.

Low incidences of local recurrences can be achieved after potentially curative resections for colorectal carcinoma. When recurrences occur, a small number can be salvaged with a re-resection which is the procedure of choice. Palliative procedures for emergent indications of obstruction and bleeding can give good palliation despite the absence of the possibility of cure.