Outcome After Curative Resection for Locally Recurrent Rectal Cancer

• Published in: Diseases of the colon & rectum Vol. 49; no. 2; pp. 175 - 182
• Main Authors: Bedrosian, Isabelle, Giacco, Geoffrey, Pederson, Lee, Rodriguez-Bigas, Miguel A, Feig, Barry, Hunt, Kelly K, Ellis, Lee, Curley, Steven A, Vauthey, Jean Nicolas, Delclos, Marc, Crane, Christopher H, Janjan, Nora, Skibber, John M
• Format: Journal Article
• Language: English
• Published: Secaucus, NJ The ASCRS 01-02-2006; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers, Tumor - biosynthesis; Carcinoembryonic Antigen - biosynthesis; Colectomy; Combined Modality Therapy; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genes, bcl-2 - physiology; Humans; Ki-67 Antigen - biosynthesis; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - surgery; Rectal Neoplasms - metabolism; Rectal Neoplasms - surgery; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Treatment Outcome; Tumor Suppressor Protein p53 - biosynthesis; Tumors; Relapse; Rectal disease; Prognosis; Pelvic recurrence; Rectal cancer; Surgical resection; Carcinoembryonic antigen; Treatment; Surgery; Outcome; Gastroenterology; Digestive diseases; Intestinal disease; Anorectal disease
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-005-0276-5

PURPOSE:
METHODS:
RESULTS:From 1988 to 1998, 134 patients with locally recurrent rectal cancer underwent operative exploration. Curative resection was performed in 85 patients. Median follow-up was 43 (range, 1.3-149) months. On multivariate analysis, negative predictors of overall survival included an elevated carcinoembryonic antigen level (P = 0.02; hazard ratio 2.41; 95 percent confidence interval, 1.19-4.89) and an R1 resection margin (P = 0.01; hazard ratio, 2.81; 95 percent confidence interval, 1.27-6.21). In 26 patients for whom biologic variables were available, p53, bcl-2, and ki-67 did not significantly impact disease-specific survival or overall survival. Five-year disease-specific survival, overall survival, and pelvic control rates were 46, 36, and 51 percent respectively. Of the 50 patients who relapsed, time to second local recurrence was longer than time to development of metastasis (median, 16.5 vs. 9 months). Median survival for patients with metastatic recurrence was 26.l vs. 41.5 months for those with a subsequent local recurrence alone.
CONCLUSIONS: