Rectal cancer recurrence after prior resection and radiotherapy: palliation following additional surgery

Patients with rectal cancer may develop local recurrence despite cancer resection plus treatment with high dose radiation therapy. In this report, symptomatic patients received benefit from repeat resection. The morbidity and mortality can be maintained at an acceptable level with meticulous dissections and consistent use of reconstructive procedures.

The primary treatment of rectal carcinoma is surgical excision to remove the primary tumor and its draining lymphatic systems. Postoperative radiotherapy may be recommended if tumor has penetrated through the full thickness of the bowel wall, and where there is lymph node involvement. Despite such treatments, tumor may recur locally, producing symptoms relieved by palliative surgery.

Between 1989 and 1995, twenty patients underwent 21 reoperations for locally recurrent rectal cancer. All patients previously had not only surgical resection but also radiotherapy as treatment. The clinical data available on these patients was critically evaluated.

Eighty-nine dissections (4.5 per patient) and 39 reconstructive procedures (2.0 per patient) were required on these 20 patients to re-resect rectal cancer in an irradiated site. Major complications occurred in 4 of 21 reoperative procedures (19%). There were no mortalities. Palliative benefits from pain control (8 of 9 patients), resolution of uncontrolled hemorrhage (2 of 2 patients), resolution of pelvic sepsis (2 of 2 patients), and reversal of intestinal obstruction (2 of 2 patients) were clearly demonstrated. The median survival following repeat resection was 24 months.

Surgical cure following reoperation for recurrent rectal cancer treated initially with resection radiotherapy was uncommon. However, the morbidity and mortality of the procedures were acceptable, the survival was extensive and the palliative effects were substantial. The results of treatment suggest that repeat resection combined with aggressive reconstruction, is an important part of the treatment of symptomatic rectal cancer patients who recur locally, after resection combined with radiation therapy.