© 2006 Foundation for Promotion of Cancer Research
Review Article |
Treatment Strategy for Locally Recurrent Rectal Cancer
Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
For reprints and all correspondence: Yoshihiro Moriya, Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. E-mail: ymoriya{at}ncc.go.jp
Received October 15, 2004; accepted February 15, 2006
Despite radical surgery, up to 33% of patients with rectal cancer will develop locoregional relapse. The management of these patients is particularly challenging. Surgery is the mainstay of treatment for those with a mobile recurrence. However, the majority of patients develop recurrence involving the pelvic wall. In these patients, multimodality therapy including radical surgery and intraoperative radiotherapy have been reported with 5-year survival of up to 31% and local control rates of 50–71%. The most important factor for obtaining long-term local control and survival is R0 resection. Extended surgery such as abdomino-sacral resection has not been popular because of 5-year survival rates of 16–31%, and significant postoperative morbidity. Re-recurrence following surgery occurs locally and in the lung, and remains a significant problem. In surgical treatment for local recurrence, surgeon-related factors are crucial. A staging system using degree of fixation and other prognostic factors should be developed so that appropriate treatment modalities are applied to each case.
Key Words: locally recurrent rectal cancer • multimodality therapy • extended surgery
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