SURGICAL REINTERVENTION IN PATIENTS WITH LOCAL RECURRENCE OF COLORECTAL-CARCINOMA - SHOULD IT BE DONE

The role of surgery in the treatment of local recurrence of colorectal carcinoma is controversial. This study aims to analyse the value of s urgical reintervention. From July 1982 to June 1991 157 patients were treated for local recurrence after ,,curative resection'' of primary c olorectal carcinoma in our institution. The mean age was 60.3 years. I n 67 patients tumor recurred in the pelvis (45% distant metastases) an d in 90 patients in the abdomen (39% distant metastases). Intraluminal recurrence was found in 55 patients (35%), extraluminal recurrence in 102 patients (65%). The mean interval between primary tumor resection and recurrence was 24 months. The resection rate was 73,9% (n = 116). R0-resection was achieved in 38% (n = 44). There was no significant d ifference in the R0-resection rate between pelvic and abdominal recurr ences (33% vs. 41%). In contrast to that intraluminal tumors showed a significant difference in R0-resections when compared with extralumina l tumor recurrences (57% vs. 23%). In 34 patients (22%) only palliativ e surgery was performed, while in 7 patients (45%) no surgical interve ntion was possible at all. Multivisceral resections were necessary in 36% of pelvic and in 81% of abdominal recurrences. The postoperative c omplication rate was 58% (19% major complications), mortality was 3.4% . For R0-resection mean survival was 44.1 months, for R1-resection 16. 5 months and for R2-resection 10.9 months. Survival in intraluminal re currences was 42 months compared with 13.8 months in extraluminal tumo rs. Tumor location (abdominal/pelvic) had no influence on survival. Su rgical reintervention should always be considered for colorectal tumor recurrence. R0-resection is the most important prognostic factor. Int raluminal recurrences have a better prognosis than extraluminal tumors .