Patterns of local recurrence in rectal cancer after a multidisciplinary approach

• Published in: World journal of gastroenterology : WJG Vol. 17; no. 13; pp. 1674 - 1684
• Main Authors: Enríquez-Navascués, Jose M, Borda, Nerea, Lizerazu, Aintzane, Placer, Carlos, Elosegui, Jose L, Ciria, Juan P, Lacasta, Adelaida, Bujanda, Luis
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 07.04.2011
• Subjects: Clinical Trials as Topic; Combined Modality Therapy; Humans; LRS; Lymph Node Excision; Meta-Analysis as Topic; Neoplasm Recurrence, Local; Pelvic Neoplasms - pathology; Rectal Neoplasms - pathology; Rectal Neoplasms - prevention & control; Rectal Neoplasms - therapy; Risk Factors; Topic Highlight; 复发率; 多学科; 手术方法; 直肠癌; 联合治疗; 肿瘤细胞; 辅助疗法; Rectal cancer; Pattern of recurrence multidisciplinary approach; Local neoplasm recurrence pelvis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v17.i13.1674

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence （LR） rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types （perianastomotic and anterior） while lateral and posterior forms （presa-cral） have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies （short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself （pelvic subsites） also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.