Locoregional recurrence of rectal carcinoma: Surgical therapy and prognosis

In a retrospective analysis, 140 patients with locoregional recurrence of rectal carcinoma were investigated in respect of prognostic factors. Neither classification of the primary tumor nor adjuvant therapies showed any significant influence on long-term survival, calculated according to the Cutler-Ederer method. The 3- (5-) year probability of survival of 52 (18) % is significantly better in cases with local curative operations than the 3 (0) % in cases with local palliative operations. Therefore, early indication for a possible radical resection of the recurrent tumor is essential. In 37.1 %, local curative operations could be performed. The probability of long-term survival is significantly influenced by the kind of recurrence. Patients with local recurrence (anastomosis) after primary resection have the best prognosis with a 84 (33) % 3- (5-) year probability of survival. Independent of the kind of primary operation, the survival data on the remainder of patients after local curative operation for recurrent tumors are comparable. They are, however, still better than for non-curative operations. The striking differences in perioperative mortality (3 months) with regards to therapeutic intention (25 % for local palliative operations without resection, 7.1 % in cases of palliative surgery with resection and 1.9 % in cases with local curative operations) must result in criteria for resectability being determined preoperatively on the basis of intensive diagnostic measures. Thus, the rate of palliative operations without benefit for the patient may be minimized.