Background & Aim: The implementation of total mesorectal excision (TME) in surgical treatment of rectal cancer has resulted in a reduced local recurrence rate. In spite of these technical improvements and multimodal therapy concepts local recurrence still occurs in 8-16%. Tumor recurrence in the small pelvis continues to be a major challange für surgery. The only chance for cure in these patients is a new R0 resection. The aim of the study was to evaluate the rate of successfull R0 resection in patients with local recurrence of rectal cancer and the morbidity and mortality rates associated with extended surgical treatment.
Methods: Prospective observational study of all consecutive surgically treated patients with local reccurrence of rectal cancer in our department from 01st january 1995 to 30th june 2007.
Results: In that period 1314 patients with colorectal cancer underwent surgical treatment. Local recurrence of rectal cancer was diagnosed in 90 patients (7%), 52 men und 38 women, with median age of 65 years. Intraluminal recurrence was diagnosed in 18%, extraluminal tumor in 77% and both, inta- and extraluminal tumor recurrence was found in 56% of the patients. 67% of the patients (n=60) have been treated by tumor resection. In 37 patients (62%) surgery resulted in local R0 resection. R1 situation was histologically prooven in 13 patients (22%) and a local R2 situation was diagnosed in 10 patients (16%). The rate of surigical major complications was 19%: 3 lesions of the ureter, 1 lesion of the bladder, 1 leakage of colon anastomosis, 5 abscesses (intraabdominal, sacral cavity), 1 fistula of the small intestine, 2 intraabdominal bleeding, 1 prolonged intestinal paralysis and 3 disruptions of bladder function. Surgical revision rate was 4%, 30 days mortality was 5%.
Summary: (1) Most of the local recurrent tumor manifestions were located extraluminally. (2). More than 60% of the patients were treated by resection whereof in another two-thirds R0 resection succeeded. (3) Surgical treatment of local recurrence of rectal cancer is associated with a notable complication rate whereas mortality rate seem to be acceptable in comparison with morbidity. (4) Surgical treatment of local recurrence of rectal cancer should be performed primarily in specialized centers.