Abdominoperineal resection for locally recurrent rectal adenocarcinoma following low anterior resection.

Study aim: The aim of this retrospective study was to evaluate the short an d long term results of abdominoperineal resection for local recurrence foll owing low anterior resection of a rectal adenocarcinoma and to determine th e prognostic factors. Patients and methods: From January 1978 to December 1996, 35 patients (17 w omen, 18 men) with a mean age of 59.4 years, underwent an abdominoperineal resection for local recurrence after low anterior resection of a rectal ade nocarcinoma. The primary tumor was below the peritoneum in 29 cases, and th e mean security marge was 3 cm under the tumor. Tumor staging at the time o f primary surgery included 23 Dukes B, 11 Dukes C, and 1 Dukes D. The mean time elapsed between low anterior resection and local recurrence was 16.4 m onths. The histological diagnosis of recurrence was obtained preoperatively in 29 cases (82.8%). Results: Resection was curative in 12 patients and palliative only in 23 pa tients. The recurrence was intramural in 3 cases, extramural in 10 cases, a nd mixed in 22 cases. Ten patients had an extended "en bloc" resection incl uding one or several adjacent organs, and a synchronous metastasis was rese cted in 2 cases. The mortality rate was 2.8% (n=1) and the morbidity rate w as 23% (n=8). The 1-year and 5-year survival rates were respectively 77 and 30.2% with the univariate analysis of prognosis factors of survival, there were four pretherapeutic factors (age, staging of the primary tumor, delay of the recurrence, CEA rate) and four therapeutic factors (curative resect ion, extramural recurrence, staging of the recurrence, postoperative radiot herapy). The curative or not curative type of resection was the only indepe ndent predictor of survival with multivariate analysis. Conclusion: The results of this study seem to justify an abdominoperinal re section for local recurrence after low anterior resection whenever possible . Long-term results may possibly be improved by using adjuvant treatment. ( C) 2001 Editions scientifiques et medicales Elsevier SAS.