RESULTS OF SURGICAL-TREATMENT OF LOCAL AN D LOCOREGIONAL RECURRENT RECTAL-CANCER - AN ANALYSIS OF 54 PATIENTS

The role of secondary resections of locally and locoregionally recurre nt rectal cancer is still unclear concerning local tumor control and s urvival. A retrospective study of 54 patients undergoing resections of recurrent rectal cancer from 1984 to 1992 was done to define the role of secondary surgery and additive or adjuvant therapies. Extended res ections of adjacent organs were performed in 37 patients. Potentially curative surgery was possible in only 7/54 patients, in 14 patients mi croscopically residual tumor (8 of these patients receiving intraopera tive radiation therapy [IORT], and in 33 patients (11 of these cases w ith distant metastases) macroscopic tumor had to be left. A preoperati ve or postoperative radiation therapy partly in combination with IORT, hyperthermia or chemotherapy was applied in 26 patients. Median survi val was 12.5 months in all patients, 19 months in patients without dis tant metastases and 8 months in patients with distant metastases, resp ectively. Radical surgery and localisation of the recurrent tumors wer e the main prognostic factors: Median survival of patients without dis tant metastases (n=43) was 17 months in patients with pelvic wall recu rrence, 33 months in patients with anastomotic or perineal recurrence and 39, 20 and 16 months in R0-, R1 and R2-resected patients, respecti vely. Local tumor control was achieved in only 10 of all patients, but in 4 of 8 patients receiving IORT. In total, only 5 of 54 patients ar e cured potentially. In conclusion, resection of recurrent rectal canc er, even in combination with additive or adjuvant therapies, only rare ly leads to local tumor control and final cure.