Locally recurrent rectal cancer: prognostic factors and long-term outcomes of multimodal therapy.

BACKGROUND: Pelvic recurrent rectal cancer is still a challenging clinical problem, and patients generally have a dismal prognosis and a poor quality of life. Surgical resection represents the only potentially curative treatment; neoadjuvant treatments are presently being taken into consideration to increase the resectability rate and to improve long-term survival.

METHODS: Among 157 patients observed with recurrent rectal cancer, a series of 58 patients who underwent surgical exploration with curative intent for isolated local recurrence at a single referral institution was retrospectively analyzed. Demographic, pathologic, and therapeutic factors were evaluated to assess long-term prognosis and local control.

RESULTS: Forty-four (75.9%) of 58 patients underwent surgical resection. The overall 5-year survival rate for patients who underwent surgical resection was 54.2%, whereas none of the unresected patients lived 5 years (P < 0.001). Patients with R0 resection showed a statistically higher 5-year overall survival and local control rate (72.4 and 70.2%, respectively) compared to R1 patients (37.5 and 31.2%, respectively). At multivariate survival analysis, feasibility of a surgical resection and radicality of excision proved to be independent positive prognostic factors. In contrast, increased presalvage carcinoembryonic antigen serum levels, back pain at diagnosis, and an increasing degree of fixation of recurrent disease to the pelvic wall at preoperative computed tomographic scan were statistically significantly linked to decreased overall survival. Preoperative chemoradiation and radicality of the surgical excision independently influenced the local control among surgically resected patients.

CONCLUSIONS: Surgical resection still remains the most important therapeutic and prognostic factor for patients with locally recurrent rectal cancer. Multimodal treatments can be safely performed by an experienced team in referral tertiary centers and can result in a safer outcome, better local disease control, and even long-term survival in carefully selected patients.