CURATIVE REOPERATIONS FOR LOCALLY RECURRENT RECTAL-CANCER

PURPOSE: Our aims were to determine the morbidity, survival and its in fluencing factors, and patterns of failure for patients who underwent further surgery with the hope of cure for locally recurrent rectal can cer. METHODS: Between January 1981 and December 1988, 224 patients wit h a preoperative diagnosis of recurrent rectal cancer underwent additi onal surgery at Mayo Medical Center in Rochester, Minnesota. Of these, 65 underwent further surgery with the hope of cure, i.e., no gross/mi croscopic residual disease at tumor margins after reoperation. Factors assessed included type of original operation, time interval between o peration for primary tumor and initial operation for recurrence, sympt om status, degree of fixation, types of reoperations for recurrence, a nd adjuvant therapy. RESULTS: None of the patients died within 30 days of reoperation. Seventeen complications requiring hospitalization and /or surgical procedure were observed in 14 patients. Extended operatio ns (involving partial or complete removal of surrounding organs/struct ures) required more time to perform, a greater number of transfusions, and a longer hospital stay than more limited operations. Three-year, five-year, and median survival were 57, 34, and 44.7 months, respectiv ely. Survival was greater after curative than after palliative resecti on (P < 0.001). Survival tended to be greater in females (P < 0.075) a nd in patients without pain (P < 0.065). Cumulative probability of loc al failure was 24, 41, and 17 percent at 1, 3, and 5 years, respective ly. Cumulative risk of distant metastasis was 30, 51, and 62 percent a t 1, 3, and 5 years, respectively. CONCLUSIONS: Our results indicate t hat complete excision of locally recurrent rectal cancer can provide a significant number of patients with long-term survival and can be acc omplished safely in select patients.