Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica

Local recurrence after rectal cancer resection varies between 3 to 35% in five years. The condition has difficult management, and little is known about the best treatment. Radiotherapy and chemotherapy can be used as paliative methods, and the best results are achieved with radical resection. PURPOSE: To evaluate patients submitted to surgery for pelvic recurrence by the Coloproctology Unit at Clinical Hospital of Unicamp. METHODS AND PATIENTS: Between 1999 and 2007, 26 consecutive patients with locally recurrence after rectal cancer surgery were evaluated. According to clinical data, tumor stage at the first surgery, recurrence ressecability and follow-up were analyzed. RESULTS: The most common initial surgery was retossigmoidectomy with colorectal anastomosis (46,1%). Of the 26 patients, five had tumor perforation at the first surgery. Positive lynphnodes were found in 53,8% and 69,2% were classified as T3 or T4 staging. In relation to surgery for local recurrence, the principle was abdominoperineal amputation of the rectum. Radical surgery was performed in 42,3% of the cases. The resection of the tumor was possible in 65,4%. The mean follow-up period was 29,4 months, with an overall survival of 34,6%. CONCLUSION: Approximately two-thirds of patients with locally recurrent rectal cancer can be submitted for surgical resection, improving survival. This surgical intervention should be encouraged in hospitals with multidisciplinary teams to improve quality of life in selected patients.

[1]  A. Darzi,et al.  Surgery for local recurrence of rectal cancer , 2006, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[2]  Rieken,et al.  [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer]. , 2001, Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].

[3]  A. Ketcham,et al.  Sacral resection for control of pelvic tumors. , 1992, American journal of surgery.

[4]  A. B. Barnes,et al.  Comparison of Histologic and Colposcopic Findings in DES-Exposed Females , 1978, Obstetrics and gynecology.

[5]  O Søreide,et al.  Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer , 2002, The British journal of surgery.

[6]  S. Akiba,et al.  Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer , 2001, The British journal of surgery.

[7]  A. Weaver,et al.  Curative reoperations for locally recurrent rectal cancer , 1996, Diseases of the colon and rectum.

[8]  S. I. Cohen,et al.  Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. , 1999, Diseases of the colon and rectum.

[9]  F. Bozzetti,et al.  Prognostic significance of radial margins of clearance in rectal cancer , 1996, The British journal of surgery.

[10]  I. Nagtegaal,et al.  Circumferential Margin Involvement Is Still an Important Predictor of Local Recurrence in Rectal Carcinoma: Not One Millimeter but Two Millimeters Is the Limit , 2002, The American journal of surgical pathology.

[11]  K. Giercksky,et al.  [Treatment of locally recurrent rectal cancer]. , 2007, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[12]  I. Eardley,et al.  Surgery for Locally Recurrent Rectal Cancer , 2005, Diseases of the colon and rectum.

[13]  S. Nahas,et al.  Recent evidences of the use of 18F-fluorodeoxyglucose positron emission tomography in the management of colorectal cancer. , 2007, Journal of surgical education.

[14]  J. Guillem,et al.  Predictors of Survival in Recurrent Rectal Cancer After Resection and Intraoperative Radiotherapy , 2002, Diseases of the colon and rectum.

[15]  B. Cedermark,et al.  A Population-Based Study on the Management and Outcome in Patients with Locally Recurrent Rectal Cancer , 2007, Annals of Surgical Oncology.

[16]  P. Quirke,et al.  Role of circumferential margin involvement in the local recurrence of rectal cancer , 1994, The Lancet.

[17]  N. Mulder,et al.  Treatment of locally recurrent rectal cancer, results and prognostic factors. , 2004, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[18]  R. Jakesz,et al.  Abdominosacral resection of recurrent rectal cancer in the sacrum , 1999, Diseases of the colon and rectum.

[19]  V. Fazio,et al.  Locally Recurrent Rectal Cancer: Predictors and Success of Salvage Surgery , 2001 .

[20]  M. Langer,et al.  Detection of recurrent rectal cancer with CT, MRI and PET/CT , 2007, European Radiology.

[21]  B. Minsky,et al.  Aggressive surgical management of locally advanced primary and recurrent rectal cancer , 1990, Diseases of the colon and rectum.

[22]  J. Welch,et al.  The clinical correlation of an autopsy study of recurrent colorectal cancer. , 1979, Annals of surgery.

[23]  T. Wiggers,et al.  Surgery for local recurrence of rectal carcinoma , 1996, Diseases of the colon and rectum.

[24]  P. Quirke,et al.  LOCAL RECURRENCE OF RECTAL ADENOCARCINOMA DUE TO INADEQUATE SURGICAL RESECTION Histopathological Study of Lateral Tumour Spread and Surgical Excision , 1986, The Lancet.

[25]  J. Hartley,et al.  Mesorectal Grades Predict Recurrences After Curative Resection for Rectal Cancer , 2007, Diseases of the colon and rectum.

[26]  J. Jager,et al.  Prognostic significance of radial margins of clearance in rectal cancer , 1996, The British journal of surgery.

[27]  G. Melton,et al.  Sacral Resection for Recurrent Rectal Cancer: Analysis of Morbidity and Treatment Results , 2006, Diseases of the colon and rectum.

[28]  E. Hughes,et al.  Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients , 1985, The British journal of surgery.

[29]  S. Cha,et al.  Curative Potential of Multimodality Therapy for Locally Recurrent Rectal Cancer , 2003, Annals of surgery.

[30]  F. Frizelle,et al.  The Role of Positron Emission Tomography in the Management of Recurrent Colorectal Cancer: A Review , 2007, Diseases of the colon and rectum.

[31]  A. Kagan,et al.  Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon , 1981, Cancer.

[32]  R. Guimbaud,et al.  Traitement chirurgical des récidives locorégionales du cancer du rectum , 2007 .

[33]  R. Aitken,et al.  Mesorectal excision for rectal cancer , 1996, The British journal of surgery.

[34]  K. Matzel,et al.  Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer , 2000, Diseases of the colon and rectum.

[35]  V. Fazio,et al.  Locally recurrent rectal cancer , 2001, Diseases of the colon and rectum.

[36]  P. Quirke,et al.  Rates of Circumferential Resection Margin Involvement Vary Between Surgeons and Predict Outcomes in Rectal Cancer Surgery , 2002, Annals of surgery.