Resection of Isolated Pelvic Recurrences After Colorectal Surgery: Long-Term Results and Predictors of Improved Clinical
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DOI: 10.1245/s10434-006-9266-7
Resection of Isolated Pelvic Recurrences After Colorectal Surgery: Long-Term Results and Predictors of Improved Clinical Outcome Leonard R. Henry, MD,1 Elin Sigurdson, MD, PhD,1 Eric A. Ross, PhD,2 John S. Lee, MD,1 James C. Watson, MD,1 Jonathan D. Cheng, MD,3 Gary M. Freedman, MD,4 Andre Konski, MD,4 and John P. Hoffman, MD1
1
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA 2 Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA 3 Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA 4 Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
Background: Recurrence in the pelvis after resection of a rectal or rectosigmoid cancer presents a dilemma. Resection offers the only reasonable probability for cure, but at the cost of marked perioperative morbidity and potential mortality. Clinical decision making remains difficult. Methods: Patients who underwent resection with curative intent for isolated pelvic recurrences after curative colorectal surgery from 1988 through 2003 were reviewed retrospectively. Clinical and pathological factors, salvage operations, and complications were recorded. The primary measured outcome was overall survival. Univariate and multivariate analyses were conducted to identify prognostic factors of improved outcome. Results: Ninety patients underwent an attempt at curative resection of a pelvic recurrence; median follow-up was 31 months. Complications occurred in 53% of patients. Operative mortality occurred in 4 (4.4%) of 90 patients. Median overall survival was 38 months, and estimated 5-year survival was 40%. A total of 51 of 86 patients had known recurrences (15 local, 16 distant, 20 both). Multivariate analysis revealed that preoperative carcinoembryonic antigen level and final margin status were statistically significant predictors of outcome. Conclusions: The resection of pelvic recurrences after colorectal surgery for cancer can be performed with low mortality and good long-term outcome; however, morbidity from such procedures is high. Low preoperative carcinoembryonic antigen and negative margin of resection predict improved survival. Key Words: Colorectal cancer—Pelvis—Recurrence—Resection.
Colorectal cancer is the third leading cause of cancer mortality in the United States, with 150,000 new cases annually resulting in nearly 57,000 deaths. Rectal cancers accounted for approximately a third of this incidence and 8500 deaths in 2002.1,2 Surgical
resection represents the cornerstone of effective therapy for primary disease. The disease of 50% of patients will recur after definitive resection of a rectal cancer. Of disease that fails to respond to therapy, approximately 70% will be solitary and distributed equally among the lungs, liver, and pelvis.3 Surgical series report local recurrence after rectal cancer resection to occur in 4% to 38% of patients.4,5 If patients with local recurren
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