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Resection of Isolated Pelvic Recurrences after Colorectal Surgery: Long-Term Results and Predictors of Improved Clinical Outcome

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A Correction to this article was published on 14 June 2021

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Abstract

Background

Recurrence in the pelvis after resection of a rectal or rectosigmoid cancer presents a dilemma. Resection offers the only reasonable probability for cure, but at the cost of perioperative morbidity and potential mortality. Clinical decision making remains difficult.

Methods

Patients resected with curative intent for isolated pelvic recurrences after curative colorectal surgery from 1988 through 2003 were reviewed retrospectively. Clinical and pathologic factors, salvage operations, and complications were recorded. The primary measured outcome was overall survival. Univariate and multivariate analyses were conducted to identify prognostic factors of improved outcome.

Results

Ninety patients underwent an attempt at curative resection of a pelvic recurrence with median follow-up of 31 months. Complications occurred in 53% of patients. Operative mortality was 4.4% (4 of 90). Median overall survival was 38 months, and estimated 5-year survival was 40%. A total of 51 of 86 patients had known recurrences (15 local, 16 distant, 20 both). Multivariate analysis revealed that preoperative carcinoembryonic antigen level and final margin status were statistically significant predictors of outcome.

Conclusions

The resection of pelvic recurrences after colorectal surgery for cancer can be performed with low mortality and good long-term outcome; however, morbidity from such procedures is high. Low preoperative carcinoembryonic antigen and negative margin of resection predict improved survival.

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Authors and Affiliations

  1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, USA

    Leonard R. Henry MD, Elin Sigurdson MD, PhD, John S. Lee MD, James C. Watson MD & John P. Hoffman MD

  2. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, USA

    Eric A. Ross PhD

  3. Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, USA

    Jonathan D. Cheng MD

  4. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, USA

    Gary M. Freedman MD & Andre Konski MD

Authors
  1. Leonard R. Henry MD
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  2. Elin Sigurdson MD, PhD
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  3. Eric A. Ross PhD
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  4. John S. Lee MD
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  5. James C. Watson MD
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  6. Jonathan D. Cheng MD
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  7. Gary M. Freedman MD
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  8. Andre Konski MD
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  9. John P. Hoffman MD
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Correspondence to John P. Hoffman MD.

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Henry, L.R., Sigurdson, E., Ross, E.A. et al. Resection of Isolated Pelvic Recurrences after Colorectal Surgery: Long-Term Results and Predictors of Improved Clinical Outcome. Ann Surg Oncol 14, 2000–2009 (2007). https://doi.org/10.1245/s10434-006-9343-y

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  • DOI: https://doi.org/10.1245/s10434-006-9343-y

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