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Prognostic Impact of Intra-abdominal/Pelvic Inflammation After Radical Surgery for Locally Recurrent Rectal Cancer

Tanaka, Masahiro M.D.1,2; Kanemitsu, Yukihide M.D.1; Shida, Dai M.D.1; Ochiai, Hiroki M.D.1; Tsukamoto, Shunsuke M.D.1; Nagino, Masato M.D.2; Moriya, Yoshihiro M.D.3

Diseases of the Colon & Rectum: August 2017 - Volume 60 - Issue 8 - p 827–836
doi: 10.1097/DCR.0000000000000853
Original Contributions: Colorectal/Anal Neoplasia
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BACKGROUND: The influence of postoperative infectious complications, such as anastomotic leakage, on survival has been reported for various cancers, including colorectal cancer. However, it remains unclear whether intra-abdominal/pelvic inflammation after radical surgery for locally recurrent rectal cancer is relevant to its prognosis.

OBJECTIVE: The purpose of this study was to evaluate factors associated with survival after radical surgery for locally recurrent rectal cancer.

DESIGN: The prospectively collected data of patients were retrospectively evaluated.

SETTINGS: This study was conducted at a single-institution tertiary care cancer center.

PATIENTS: Between 1983 and 2012, patients who underwent radical surgery for locally recurrent rectal cancer with curative intent at the National Cancer Center Hospital were reviewed.

MAIN OUTCOME MEASURES: Factors associated with overall and relapse-free survival were evaluated.

RESULTS: During the study period, a total of 180 patients were eligible for analyses. Median blood loss and operation time for locally recurrent rectal cancer were 2022 mL and 634 minutes. Five-year overall and 3-year relapse-free survival rates were 38.6% and 26.7%. Age (p = 0.002), initial tumor stage (p = 0.03), pain associated with locally recurrent rectal cancer (p = 0.03), CEA level (p = 0.004), resection margin (p < 0.001), intra-abdominal/pelvic inflammation (p < 0.001), and surgery period (p = 0.045) were independent prognostic factors associated with overall survival, whereas CEA level (p = 0.01), resection margin (p = 0.002), and intra-abdominal/pelvic inflammation (p = 0.001) were associated with relapse-free survival. Intra-abdominal/pelvic inflammation was observed in 45 patients (25.0%). A large amount of perioperative blood loss was the only factor associated with the occurrence of intra-abdominal/pelvic inflammation (p = 0.007).

LIMITATIONS: This study was limited by its retrospective nature and heterogeneous population.

CONCLUSIONS: Intra-abdominal/pelvic inflammation after radical surgery for locally recurrent rectal cancer is associated with poor prognosis. See Video Abstract at

1 Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan

2 Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

3 Surgery Division, Miki Hospital, Iwate, Japan

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Yukihide Kanemitsu, M.D., Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons