BACKGROUND:
Local excision for early rectal cancer has gained widespread interest. Currently available imaging modalities have low sensitivity to detect locoregional disease, which may result in understaging and a high risk of recurrence after local excision.
OBJECTIVE:
The purpose of this work was to study the morbidity, mortality, and long-term oncologic outcomes in a select cohort of patients undergoing salvage surgery for local recurrence after local excision of early rectal cancer.
DESIGN:
A retrospective review of patient charts was used to determine patterns of disease recurrence and outcomes as a single-institution case series.
SETTINGS:
The study was conducted at a tertiary care cancer center.
PATIENTS:
The study cohort included patients with early rectal cancer treated by local excision who then developed local recurrence for which a multimodal salvage surgery with curative intent was performed between 1997 and 2013 at our center.
MAIN OUTCOME MEASURES:
Log rank tests were used to measure overall and disease-free survival.
RESULTS:
Twenty-seven patients were identified, with a mean age of 66 ± 12 years. The median time to recurrence was 54 weeks (range, 7–326 weeks). Recurrent disease was luminal in 23 patients, regional (involving both mesorectal and pelvic lymph nodes) in 6 patients, and both luminal and nodal in 2 patients. For salvage surgery, neoadjuvant chemoradiation was used in 12 patients (44%), and radiation alone was used in 1 patient. Sphincter-preserving surgery was performed in 9 patients (33%). R0 resection was achieved in 25 patients (93%). Four patients received intraoperative radiation therapy. Five-year overall survival was 50% (95% CI, 30%–74%), and re–recurrence-free survival was 47% (95% CI, 25%–68%).
LIMITATIONS:
This study was limited by its retrospective nature, small patient cohort, referral bias, and selection bias.
CONCLUSIONS:
Even in highly selected patients who undergo surgery for local recurrence after transanal excision of early stage rectal cancer, oncologic outcomes are poor.
