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Is Curative Resection and Long-term Survival Possible for Locally Re-recurrent Colorectal Cancer in the Pelvis?

Colibaseanu, Dorin T. M.D.1; Mathis, Kellie L. M.D.2; Abdelsatter, Zaid M. M.D.1; Larson, David W. M.D.2; Haddock, Michael G. M.D.3; Dozois, Eric J. M.D.2

Diseases of the Colon & Rectum: January 2013 - Volume 56 - Issue 1 - p 14–19
doi: 10.1097/DCR.0b013e3182741929
Original Contribution: Colorectal/Anal Neoplasia

BACKGROUND: A multimodality approach for locally recurrent colorectal cancer in the pelvis provides a significant survival advantage when negative margins are achieved. However, outcomes of surgical resection in patients who have locally re-recurrent disease in the pelvis are not well studied. Our aim was to assess the safety, feasibility of a negative margin resection, and survival outcomes in patients with pelvic locally re-recurrent colorectal cancer.

DESIGN: A retrospective review identified 406 patients who underwent surgery for locally recurrent colorectal cancer between 1997 and 2007. Patients who had locally re-recurrent disease in the pelvis who underwent curative-intent resection were identified.

RESULTS: Forty-seven patients (31 male) were identified. Median age was 57 years (range, 30–84 years). Median time to re-recurrence was 2.4 years (range, 0.5–5.6 years). Margin status following re-resection was R0 60%, R1 32%, and R2 8%. Nonbowel organs were resected en bloc in 81%, including 7 sacral resections. Intraoperative radiation was given to 77%. Morbidity occurred in 42%, with 6% requiring reoperation for complications. Thirty-day mortality was nil. Overall survival at 2 and 5 years was 83% and 33%. Disease-free survival at 2 and 5 years was 55% and 27%. Five-year survival for patients who had R0 and R1 resections was 37% and 42%, whereas no patients having an R2 resection survived beyond 2 years (p = 0.002).

CONCLUSIONS: In highly selected patients with re-recurrent colorectal cancer in the pelvis, we found that surgery could be performed safely and that a curative (R0) resection was possible in more than 50%. Two- and 5-year survival rates are comparable to results seen when surgery is done for first-time recurrences.

1 Department of Surgery, Division of General Surgery, Mayo Clinic, Rochester, Minnesota

2 Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

3 Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Eric J. Dozois, M.D., Colon & Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: Dozois.Eric@mayo.edu

© The ASCRS 2013