Prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer: impact of patterns of pelvic recurrence on curative resection.

BACKGROUND: The purpose of this study is to investigate prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer and determine whether recurrence patterns influence curative resection of recurrent tumor.

MATERIALS AND METHODS: We examined 62 patients with isolated local recurrence following total mesorectal excision (TME) of the primary rectal cancer. Recurrence patterns were classified as central, anterior, posterior, lateral, and perineal with respect to the intra-pelvic tumor location. Prognostic factors affecting oncologic outcomes were analyzed, and the rate of curative resection was analyzed according to recurrence patterns.

RESULTS: The mean follow-up period was 49.0 +/- 29.0 months, and the mean time to recurrence after TME was 27.9 +/- 23.3 months. Twenty-three patients underwent curative resection, and the remaining 39 patients received palliative treatment. Patients with a central recurrence had the highest rate of curative resection (p = 0.006). The overall 5-year survival rate was 13.9% and significantly higher in those treated with curative resection (35.1%; p = 0.0002). Multivariate analysis demonstrated that disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors influencing 5-year survival.

CONCLUSION: Patients with central recurrences have a high probability of curative resection. Disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer.