Résultats de l'exérèse des récidives locorégionales des cancers du rectum

Aims of the study

The treatment of locally recurrent rectal cancer (LRRC) remains a difficult and controversial issue. The aim of this study was to retrospectively assess the results of an univocal attitude associating resection of a priori resectable lesions using visceral excisions as required, without sacral excision, but including intra-operative radiotherapy (IORT).

Patients and methods

Between 1989 and 1999, 32 patients underwent resection for LRRC. Twelve had previously undergone abdomino-perineal excision and 22 had received radiotherapy. Twenty-three patients underwent pelvic exenteration (total in 17, with rectus myocutaneous flap in 18). Twenty-five patients underwent IORT.

Results

Three patients (9.3%) died in the early postoperative period and 11 experienced complications (37%). Resections were considered R0 in 6 patients, R1 in 21 patients and R2 in 5 patients. Five-year survival rates, overall and without disability, were respectively 12%, 12% and 5%. Median survivals, overall and without disability, were respectively 22 and 12 months.

Conclusion

Resection of LRRC remains a surgical challenge. It may achieve an average of one-year survival without disability, and hope for a few cures. Improvement of oncologic results might come from a more accurate patient selection.