Benefits of radioimmunoguided surgery for pelvic recurrence

Aim: Surgery for recurrent rectal cancer is usually traumatic and of questi onable curative value. The use of radioimmunoguided surgery (RIGS(R)) in en hancing the surgeon's assessment of the extent of disease in these patients was investigated. Methods: Twenty-one patients diagnosed with recurrent pelvic cancer were op erated using the RIGS(R) system. Preoperative assessment included CTs of ch est, abdomen and pelvis as well as colonoscopy. Patients were injected with CC49, a monoclonal antibody (MoAb) labelled with I-125. Surgical explorati on was followed by survey with the gamma-detecting probe. Results: Surgical exploration identified eight intra-colorectal recurrences , nine extra-colonic pelvic recurrences and five extra-pelvic lymph node me tastases. RIGS exploration confirmed all intra-colonic recurrences except f or one (patient with no MoAb localization), identified 13 pelvic recurrence s and 10 lymph node metastases. There were seven patients with occult findi ngs (33%), resulting in a modified surgical procedure. Surgery included fiv e abdominoperineal resections, six low anterior resections, seven excisions of presacral tumour, eight total abdominal hysterectomy and bilateral salp ingo-oophorectomy, one pelvic exenteration and one post-exenteration. There were no operative deaths. Eight patients had minor complications, and one patient had a major complication with reoperation due to urinary leak. The mean follow-up was 18 months. Ten patients died of disease. Conclusion: Although not curative, RIGS can help the surgeon in the decisio n-making process through better disease staging. (C) 2001 Harcourt Publishe rs Ltd.