[Surgery of loco-regional recurrences in colorectal cancer]

By the term of local recurrence (LR), after apparently curative resection of a colorectal cancer, we mean the recurrence of the disease at the site of the original tumor, in correspondence to the regional lymph nodes or to intestinal anastomosis. The frequency of LR, which differs widely from one case to another because of the unhomogenity of the samples under examination, is on average around 16%, although this figure is to be considered an underestimation since it is not supported by routine autopsies. The authors analyse, together with the data in the literature, the results of their personal experience relating to 1164 patients undergoing surgery for colorectal cancer in the space of 18 years, in order to evaluate the true effectiveness of surgery on patients affected by LR. Surgery on the original tumor had a curative aim in 791 (68%) of these cases, 33 patients died during the postoperative period and 37 were lost to follow-up. Among the remaining 721 patients, recurrence was observed in 218 cases (30.2%): in 81 of these was confirmed a LR, with simultaneous distant metastasis in 45. During the same time span, 15 patients were admitted who were affected by LR from colorectal cancers treated surgically in other hospitals. Of these, only 2 had concomitant distant metastasis. 58 of these 96 patients (60.4%) underwent surgery, which had a curative aim in 22 cases (37.9%)/ Up to present, 12 patients undergoing curative surgery are still alive, 4 (33.3%) being affected by further relapse. The data reported demonstrate that in patients with proven LR surgical intervention is widely indicated, being the only therapeutic approach able to provide tangible results. However, the choice of exeresis must be carefully weighed: surgery of LR can be said to be truly curative in few cases, and thus the operative risks may not be acceptable in situations where limited results, in terms of duration and quality, are foreseen.