Treatment and outcomes of local re-recurrence in rectal cancer: a multicentre observational cohort

Abstract

Objective: This study aimed to assess patient, tumour and treatment characteristics in locally re-recurrent rectal cancer (LrRRC), and relate these to long-term oncological outcomes since limited literature on this topic is available.

Methods: A retrospective study of locally recurrent rectal cancer (LRRC) patients treated with curative intent between 1994 and 2022 in two tertiary centres in the Netherlands. Data on patient, tumour and treatment characteristics were collected. Oncological outcomes of patients treated with curative and palliative intent were displayed.

Results: Of 852 curatively treated LRRC patients, 277 (33 %) developed LrRRC. The median survival of this LrRRC group was 23 months (95 % CI 20-26). Treatment with curative intent was offered to 92/277 (33 %) patients, resulting in surgical resection in 81/277 (29 %) patients. Complete oncological clearance (R0) was achieved in 50/81 cases (62 %). Surgical resection resulted in a median survival of 35 months (95 % CI 27-43). Palliative treatment resulted in a median survival of 16 months (95 % CI 11-21). Median progression free survival (PFS) in patients treated with curative intent was 16 months (95 % CI 12-20). Median local re-re-recurrence free survival (LrrRFS) in patients who underwent surgery was 11 months (95 % CI 8-16).

Conclusion: The median OS in 277 LrRRC patients was 23 months. Aggressive treatment in selected patients resulted in a median OS of 35 months. Furthermore, locoregional control was achieved for 11 months in patients undergoing surgery. These findings underscore the need for meticulous patient selection and tailored treatment strategies to improve survival while minimising unnecessary morbidity.

Keywords: Locally re-recurrent rectal cancer; Locally recurrent rectal cancer; Oncological outcomes.