Prognostic Factors and Treatment of Recurrence after Local Excision of Rectal Cancer

Abstract

Purpose: Indications for local excision in patients with rectal cancer remain controversial. We reviewed factors affecting survival rate and treatment effectiveness in cancer recurrence after local excision among patients with rectal cancer.

Materials and methods: A total of 831 patients was enrolled. Of these, 391 patients were diagnosed with primary rectal cancer and underwent local excision. A retrospective observational study was performed on patients who underwent full-thickness local excision for rectal cancer.

Results: The median duration of follow-up was 61 months. The overall recurrence rate was 11.5%. The rate of local recurrence was 5.1%. Five-year overall survival rate among recurrent patients was 66.8%; the rate among patients who underwent salvage operation due to recurrence was 84.7%, compared with 44.2% among patients treated with non-operative management (p<0.001). Multivariate analysis of disease-free survival identified distance from the anal verge (p=0.038) and histologic grade (p=0.047) as factors predicting poor prognosis. Multivariate analysis of overall survival showed that age (p<0.001), serum carcinoembryonic antigen (CEA) levels (p=0.001), and histologic grade (p=0.013) also affected poor prognosis. In subgroup analysis of patients with recurrence, 25 patients underwent reoperation, while 20 patients did not. For 5-year overall survival rate, there was a significant difference between 84.7% of the reoperation group and 44.2% of the non-operation group (p<0.001).

Conclusion: The risk factors affecting overall survival rate after local excision were age 65 years or older, preoperative CEA level 5 or higher, and high histologic grade. In cases of recurrence after local excision of rectal cancer, salvage operation might improve overall survival.

Keywords: Rectal cancer; local excision; preoperative chemoradiotherapy; recurrence.

Fig. 1. Diagram of patient selection and recurrence outcomes. CCRT, concurrent chemoradiotherapy; FAP, familial adenomatous polyposis; HNPCC, hereditary nonpolyposis colorectal cancer; f/u, follow-up duration; LR, local recurrence; SR, systemic recurrence; CR, combined recurrence.

Fig. 2. Yearly comparison of patients with recurrence after local resection for rectal cancer (n=45).

Fig. 3. Five-year overall survival in patients who were diagnosed with primary rectal cancer who underwent local excision. The overall survival rate after 5 years of follow up was 94.4% (n=346) in the non-recurrence group and 66.8% (n=45) in the recurrence group (p<0.001; log-rank test).

Fig. 4. Five-year overall survival in patients who were treated for recurrence after local excision. The overall survival rate was 84.7% (n=25) in the salvage operation group and 44.2% (n=20) in the non-salvage group (p<0.001; log-rank test).