Surgical salvage of recurrent rectal carcinoma after curative resection: a10-year experience

Background: Local recurrence after resection of rectal carcinoma is a diffi cult clinical problem that adversely affects both survival and quality of l ife. Surgical resection is possible for a subset of patients with localized recurrences. We reviewed our experience with surgical salvage of recurrent rectal carcinoma, to determine predictors of resectability and postsalvage survival rates. Methods: A 10-year, retrospective analysis of 131 patients who underwent ex ploration with curative intent for local recurrence after radical resection of rectal carcinomas, in a single referral institution, was performed. Pre operative and pathological factors were examined for their ability to predi ct postresection survival rates and resectability. Results: The overall 5-year survival rate for patients who underwent explor ation with curative intent was 24%. Resection of recurrent disease was poss ible for 103 of 131 (79%) patients, with a resulting 5-year survival rate o f 31%. Patients who were treated initially with abdomino-perineal resection (n = 35) presented later and were less likely to have resectable tumors th an were those treated initially with some form of sphincter-preserving rese ction (n = 96). Among patients who could undergo resection, normal carcinoe mbryonic antigen levels and recurrent disease limited to the bowel wall wer e both favorable features. Conclusions: Surgical salvage of local recurrence after radical resection o f rectal carcinoma can be performed safely and can result in substantial lo ng-term survival benefits for selected patients.