The treatment of local recurrences of rectal cancer after surgical therapy is still an open problem. Even if a second look with tumoral excision is not the ideal solution, it represents, whenever feasible the best therapeutic possibility. At the Department of General Surgery and Organ Transplantation, II Medical School, Naples, out of 144 patients treated by potentially curative resection for carcinoma of the rectum between 1983 and 1987, 28 local recurrences (19.4%) were detected. Five of these (17.8%) were associated with liver metastasis. Thirteen patients were reoperated and in 10 cases it was possible to remove the recurrence with a resectability rate of 35% and 50% of reoperations were reported as radical. Operative mortality was 10% and morbidity 30%. Untreated patients or patients operated for decompressive enterostomy only, had a mean survival time of approximately 6 months. All the resected patients, after both radical and palliative operations, were alive after one year. Four of the 5 patients treated by potentially radical resection are alive and disease free at 13, 15 (2 cases) and 18 months; only one patient had a new recurrence at 22 months and died 31 months after the reoperation. After palliative resection, two patients died at 13 and 14 months and 2 patients are alive with recurrent disease at 13 and 17 months. The excision of perineal recurrences is usually not technically demanding whereas for pelvic recurrences the role of Hartmann operation should be revealed. Although a concrete outlook of cure is seldom achieved after radical resection, an acceptable long term survival is nearly always possible. Palliative operations results in longer survival as compared with non surgical treatments, with the substantial advantage of a better quality of life. Even though this study reports on a small number of patients an aggressive surgical approach seems, to date, justified because of the inefficacy of alternative forms of treatment.
Surgical treatment of recurrences after rectal cancer surgery. Indications and results / Romano, G.; Esercizio, L.; Santangelo, M.; Iovino, F.; Giordano, P.; Santangelo, M. L.. - In: CHIRURGIA. - ISSN 0394-9508. - 4:9(1991), pp. 446-450.
Surgical treatment of recurrences after rectal cancer surgery. Indications and results
Santangelo M.;
1991
Abstract
The treatment of local recurrences of rectal cancer after surgical therapy is still an open problem. Even if a second look with tumoral excision is not the ideal solution, it represents, whenever feasible the best therapeutic possibility. At the Department of General Surgery and Organ Transplantation, II Medical School, Naples, out of 144 patients treated by potentially curative resection for carcinoma of the rectum between 1983 and 1987, 28 local recurrences (19.4%) were detected. Five of these (17.8%) were associated with liver metastasis. Thirteen patients were reoperated and in 10 cases it was possible to remove the recurrence with a resectability rate of 35% and 50% of reoperations were reported as radical. Operative mortality was 10% and morbidity 30%. Untreated patients or patients operated for decompressive enterostomy only, had a mean survival time of approximately 6 months. All the resected patients, after both radical and palliative operations, were alive after one year. Four of the 5 patients treated by potentially radical resection are alive and disease free at 13, 15 (2 cases) and 18 months; only one patient had a new recurrence at 22 months and died 31 months after the reoperation. After palliative resection, two patients died at 13 and 14 months and 2 patients are alive with recurrent disease at 13 and 17 months. The excision of perineal recurrences is usually not technically demanding whereas for pelvic recurrences the role of Hartmann operation should be revealed. Although a concrete outlook of cure is seldom achieved after radical resection, an acceptable long term survival is nearly always possible. Palliative operations results in longer survival as compared with non surgical treatments, with the substantial advantage of a better quality of life. Even though this study reports on a small number of patients an aggressive surgical approach seems, to date, justified because of the inefficacy of alternative forms of treatment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
