Curative resection improves the outcome of the patients with local recurrence of rectal cancer (LRRC). On the other hand, the role of perioperative radiotherapy for LRRC still remains controversial.
To assess surgical treatment and perioperative radiotherapy for the patients with LRRC, 49 patients (male-female ratio, 29:20) who underwent the surgical treatment for LRRC in a single institution since 1990, were clinicopathologically analyzed.
27 patients (55%) had radiotherapy (preoperative (pre): 15, postoperative (post): 12). The median dose of radiation was 60 Gy (28-72). Perioperative radiotherapy tended to be carried out for the patients with LRRC, which tumor location was close to pelvic wall. Total pelvic exenteration, abdominoperineal resection, tumor excisions, Hartmann’s operation, and low anterior resection were performed in 8, 21, 12, 6 and 2 patients, respectively. Out of 49 patients, 36 patients (73%) had curative resection (R0) and 13 patients (27%) had non-curative resection (R1, R2). R0 rate was higher in the patients without radiotherapy (86%) compared to the patients with radiotherapy (pre and post: 67% and 58%, respectively). Overall complications were observed in 39 patients (80%) after surgery for LRRC. The rate of intrapelvic abscess was doubled in the patients with preoperative radiotherapy compared to the patients without radiotherapy. The median operative time, blood loss, and hospital stay after surgery were 530 min, 1966 ml, and 40 days, respectively. The hospital stay after surgery was significantly longer in the patients with preoperative radiotherapy than the patients without radiotherapy (39 vs 66 days, p = 0.018). Three-years survival rate of all 49 patients and 36 patients with R0 resection were 56% and 64%, respectively. No three-years survivors were observed in the patients with noncurative resections (R2).
Curative resection improves the prognosis of the patients with LRRC. Preoperative radiotherapy may increase the complications, resulting in prolongation of patient’s hospital stay.
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