Operative treatment of locally recurrent rectal cancer

Few centres with varying regimens have published studies including more than 100 patients on the treatment of locally recurrent rectal cancer. The results vary considerably. Thus there seems to be a need for more studies to establish the potential benefit of a more widespread treatment of these cancers. In total, 193 patients had surgery for locally recurrent rectal cancers after preoperative irradiation 46-50 Gy in 2 Gy fractions. The patients were followed up and the data prospectively entered in a database. In 88 patients with primary low anterior resection, 3% had lower end of tumour located more than 2 cm above the anastomosis, 5% more than 2 cm below the anastomosis; 13% had exploratory laparotomy, 8% low anterior resections, the rest equally frequent abdomino-perineal resections, Hartmann's operations, and tumour resections. Nearly half had resection of part of the pelvic wall. Hysterectomy was performed in 15% and cystoprostatectomy in 9%. Three patients had en bloc prostatectomy. R0 resections were achieved in 39%, R1 in 36%, and R2 or no resection in 25%. R0 stage was twice as often achieved after a primary low anterior resection as after abdomino-perineal resections. The 30-days postoperative mortality was 1%. Postoperative morbidity was 48%, most frequently pelvic abscesses. Estimated 5-year survival was 18% for the total group. There was a statistically significant difference in survival and local re-recurrences between R0 / R1 and R2 stages. The results are discussed relative to recent studies. Patients in whom R0 resections can be achieved will benefit from the treatment, and probably patients with R1 resections would also benefit. Such operations should possibly be performed in specialised centres as joint ventures between various surgical subspecialities.