Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000049.xml
Download PDF
Clin Colon Rectal Surg 2007; 20(3): 255-264
DOI: 10.1055/s-2007-984870
DOI: 10.1055/s-2007-984870
Management of Locally Advanced Primary and Recurrent Rectal Cancer
Further Information
Publication History
Publication Date:
31 July 2007 (online)
ABSTRACT
Treatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality treatment, including preoperative chemoradiation protocols, intraoperative radiotherapy, and extended surgical resections. Much effort should be made to select patients with these advanced tumors for treatment in specialized referral centers. This has been shown to reduce morbidity and mortality and improve long-term survival rates. In this article, we review the best treatment options for patients with locally advanced and recurrent rectal cancer. We also emphasize the necessity of a multidisciplinary team, including a radiologist, radiation oncologist, urologist, surgical oncologist, plastic surgeon, and gynecologist in the diagnosis and treatment of patients with these pelvic tumors.
KEYWORDS
Primary locally advanced rectal cancer - recurrent rectal cancer - surgery - radiotherapy
REFERENCES
- 1 Kapiteijn E, Marijnen C A, Nagtegaal I D et al.. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001; 345 638-646
- 2 Vermaas M, Ferenschild F T, Nuyttens J J et al.. Preoperative radiotherapy improves outcome in recurrent rectal cancer. Dis Colon Rectum. 2005; 48 918-928
- 3 Sasson A R, Sigurdson E R. Management of locally advanced rectal cancer. Surg Oncol. 2000; 9 193-204
- 4 Popovich M J, Hricak H, Sugimura K, Stern J L. The role of MR imaging in determining surgical eligibility for pelvic exenteration. AJR Am J Roentgenol. 1993; 160 525-531
- 5 Shank B, Dershaw D D, Caravelli J, Barth J, Enker W. A prospective study of the accuracy of preoperative computed tomographic staging of patients with biopsy-proven rectal carcinoma. Dis Colon Rectum. 1990; 33 285-290
- 6 Kim N K, Kim M J, Park J K, Park S I, Min J S. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness. Ann Surg Oncol. 2000; 7 732-737
- 7 Brown G, Richards C J, Newcombe R G et al.. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999; 211 215-222
- 8 Beets-Tan R G, Beets G L, Vliegen R F et al.. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001; 357 497-504
- 9 Beets-Tan R G, Beets G L, Borstlap A C et al.. Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI?. Abdom Imaging. 2000; 25 533-541
- 10 Messiou C, Chalmers A, Boyle K, Sagar P. Surgery for recurrent rectal carcinoma: The role of preoperative magnetic resonance imaging. Clin Radiol. 2006; 61 250-258
- 11 Boyle K M, Petty D, Chalmers A G et al.. MRI assessment of the bony pelvis may help predict resectability of rectal cancer. Colorectal Dis. 2005; 7 232-240
- 12 Burton S, Norman A R, Brown G, Abulafi A M, Swift R I. Predictive poor prognostic factors in colonic carcinoma. Surg Oncol. 2006; 15 71-78
- 13 Sauer R, Becker H, Hohenberger W et al.. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351 1731-1740
- 14 Ferenschild F T, Vermaas M, Nuyttens J J et al.. Value of intraoperative radiotherapy in locally advanced rectal cancer. Dis Colon Rectum. 2006; 49 1257-1265
- 15 Gerard J P, Conroy T, Bonnetain F et al.. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006; 24 4620-4625
- 16 Bosset J F, Collette L, Calais G et al.. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006; 355 1114-1123
- 17 Bosset J F, Calais G, Daban A et al.. Preoperative chemoradiotherapy versus preoperative radiotherapy in rectal cancer patients: assessment of acute toxicity and treatment compliance. Report of the 22921 randomised trial conducted by the EORTC Radiotherapy Group. Eur J Cancer. 2004; 40 219-224
- 18 Yerushalmi R, Idelevich E, Dror Y et al.. Preoperative chemoradiation in rectal cancer: retrospective comparison between capecitabine and continuous infusion of 5-fluorouracil. J Surg Oncol. 2006; 93 529-533
- 19 Kim J S, Cho M J, Song K S, Yoon W H. Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2002; 54 403-408
- 20 Klautke G, Kuchenmeister U, Foitzik T et al.. Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study. Br J Cancer. 2006; 94 976-981
- 21 Mohiuddin M, Winter K, Mitchell E et al.. Randomized phase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012. J Clin Oncol. 2006; 24 650-655
- 22 Rodel C, Liersch T, Hermann R M et al.. Multicenter phase II trial of chemoradiation with oxaliplatin for rectal cancer. J Clin Oncol. 2007; 25 110-117
- 23 Chau I, Brown G, Cunningham D et al.. Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol. 2006; 24 668-674
- 24 Willett C G, Boucher Y, di Tomaso E et al.. Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nat Med. 2004; 10 145-147
- 25 Nuyttens J J, Robertson J M, Yan D, Martinez A. The influence of small bowel motion on both a conventional three-field and intensity modulated radiation therapy (IMRT) for rectal cancer. Cancer Radiother. 2004; 8 297-304
- 26 Ortholan C, Francois E, Thomas O et al.. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer: evidence from randomized trials. Dis Colon Rectum. 2006; 49 302-310
- 27 Mannaerts G H, Rutten H J, Martijn H, Groen G J, Hanssens P E, Wiggers T. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum. 2001; 44 806-814
- 28 Bussieres E, Gilly F N, Rouanet P et al.. Recurrences of rectal cancers: results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative Radiation Therapy. Int J Radiat Oncol Biol Phys. 1996; 34 49-56
- 29 Hahnloser D, Nelson H, Gunderson L L et al.. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg. 2003; 237 502-508
- 30 Heald R J, Moran B J, Ryall R D, Sexton R, MacFarlane J K. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998; 133 894-899
- 31 Bujko K, Nowacki M P, Nasierowska-Guttmejer A et al.. Prediction of mesorectal nodal metastases after chemoradiation for rectal cancer: results of a randomised trial: implication for subsequent local excision. Radiother Oncol. 2005; 76 234-240
- 32 Mannaerts G H, Martijn H, Crommelin M A, Dries W, Repelaer van Driel O J, Rutten H J. Feasibility and first results of multimodality treatment, combining EBRT, extensive surgery, and IOERT in locally advanced primary rectal cancer. Int J Radiat Oncol Biol Phys. 2000; 47 425-433
- 33 Nakfoor B M, Willett C G, Shellito P C, Kaufman D S, Daly W J. The impact of 5-fluorouracil and intraoperative electron beam radiation therapy on the outcome of patients with locally advanced primary rectal and rectosigmoid cancer. Ann Surg. 1998; 228 194-200
- 34 Palmer G, Martling A, Blomqvist L, Cedermark B, Holm T. Outcome after the introduction of a multimodality treatment program for locally advanced rectal cancer. Eur J Surg Oncol. 2005; 31 727-734
- 35 Willett C G, Shellito P C, Tepper J E, Eliseo R, Convery K, Wood W C. Intraoperative electron beam radiation therapy for primary locally advanced rectal and rectosigmoid carcinoma. J Clin Oncol. 1991; 9 843-849
- 36 Nagtegaal I D, Marijnen C A, Kranenbarg E K, van de Velde C J, van Krieken J H. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol. 2002; 26 350-357
- 37 Yiu R, Wong S K, Cromwell J, Madoff R D, Rothenberger D A, Garcia-Aguilar J. Pelvic wall involvement denotes a poor prognosis in T4 rectal cancer. Dis Colon Rectum. 2001; 44 1676-1681
- 38 Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005; 92 756-763
- 39 Shimoyama M, Yamazaki T, Suda T, Hatakeyama K. Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2 Dis Colon Rectum. 2003; 46 333-339
- 40 Watanabe T, Tsurita G, Muto T et al.. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002; 132 27-33
- 41 Ueno H, Mochizuki H, Hashiguchi Y et al.. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg. 2007; 245 80-87
- 42 Wang C, Zhou Z G, Yu Y Y et al.. Patterns of lateral pelvic lymph node metastases and micrometastases for patients with lower rectal cancer. Eur J Surg Oncol. 2007; 33(4) 463-467
- 43 Sugihara K, Kobayashi H, Kato T et al.. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006; 49 1663-1672
- 44 Matsumoto T, Ohue M, Sekimoto M, Yamamoto H, Ikeda M, Monden M. Feasibility of autonomic nerve-preserving surgery for advanced rectal cancer based on analysis of micrometastases. Br J Surg. 2005; 92 1444-1448
- 45 Syk E, Torkzad M R, Blomqvist L, Ljungqvist O, Glimelius B. Radiological findings do not support lateral residual tumour as a major cause of local recurrence of rectal cancer. Br J Surg. 2006; 93 113-119
- 46 Koch M, Kienle P, Antolovic D, Buchler M W, Weitz J. Is the lateral lymph node compartment relevant?. Recent Results Cancer Res. 2005; 165 40-45
- 47 Topor B, Acland R, Kolodko V, Galandiuk S. Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum. 2003; 46 779-785
- 48 Klaassen R A, Nieuwenhuijzen G A, Martijn H, Rutten H J, Hospers G A, Wiggers T. Treatment of locally advanced rectal cancer. Surg Oncol. 2004; 13 137-147
- 49 Wanebo H J, Antoniuk P, Koness R J et al.. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum. 1999; 42 1438-1448
- 50 Wiig J N, Poulsen J P, Tveit K M, Olsen D R, Giercksky K E. Intra-operative irradiation (IORT) for primary advanced and recurrent rectal cancer. A need for randomised studies. Eur J Cancer. 2000; 36 868-874
- 51 Calvo F A, Gomez-Espi M, Diaz-Gonzalez J A et al.. Intraoperative presacral electron boost following preoperative chemoradiation in T3-4Nx rectal cancer: initial local effects and clinical outcome analysis. Radiother Oncol. 2002; 62 201-206
- 52 Eble M J, Lehnert T, Herfarth C, Wannenmacher M. Intraoperative radiotherapy as adjuvant treatment for stage II/III rectal carcinoma. Recent Results Cancer Res. 1998; 146 152-160
- 53 Frykholm G J, Pahlman L, Glimelius B. Treatment of local recurrences of rectal carcinoma. Radiother Oncol. 1995; 34 185-194
- 54
Adam R, Delvart V, Pascal G et al..
Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy:
a model to predict long-term survival.
Ann Surg.
2004;
240
644-657
discussion 657-658
MissingFormLabel
- 55 Mentha G, Majno P E, Andres A, Rubbia-Brandt L, Morel P, Roth A D. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006; 93 872-878
- 56 Verhoef C, Nuytens J J, Planting A ST, de Wilt J HW. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of locally advanced rectal cancer. Br J Surg. 2007; 94 250
- 57 Kapiteijn E, Marijnen C A, Colenbrander A C et al.. Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the west Netherlands. Eur J Surg Oncol. 1998; 24 528-535
- 58 Chan C L, Bokey E L, Chapuis P H, Renwick A A, Dent O F. Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour. Br J Surg. 2006; 93 105-112
- 59 Holm T, Cedermark B, Rutqvist L E. Local recurrence of rectal adenocarcinoma after 'curative' surgery with and without preoperative radiotherapy. Br J Surg. 1994; 81 452-455
- 60 Valentini V, Morganti A G, De Franco A et al.. Chemoradiation with or without intraoperative radiation therapy in patients with locally recurrent rectal carcinoma: prognostic factors and long term outcome. Cancer. 1999; 86 2612-2624
- 61 Knol H P, Hanssens P E, Rutten H J, Wiggers T. Effect of radiation therapy alone or in combination with surgery and/or chemotherapy on tumor and symptom control of recurrent rectal cancer. Strahlenther Onkol. 1997; 173 43-49
- 62 Lingareddy V, Ahmad N R, Mohiuddin M. Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1997; 38 785-790
- 63 Suzuki K, Gunderson L L, Devine R M et al.. Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer. 1995; 75 939-952
- 64 Alektiar K M, Zelefsky M J, Paty P B et al.. High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2000; 48 219-226
- 65 Saito N, Koda K, Takiguchi N et al.. Curative surgery for local pelvic recurrence of rectal cancer. Dig Surg. 2003; 20 192-200
- 66 Rodel C, Grabenbauer G G, Matzel K E et al.. Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer. Dis Colon Rectum. 2000; 43 312-319
- 67 Salo J C, Paty P B, Guillem J, Minsky B D, Harrison L B, Cohen A M. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol. 1999; 6 171-177
- 68 Mannaerts G H, Martijn H, Crommelin M A et al.. Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys. 1999; 45 297-308
- 69 Willett C G, Shellito P C, Tepper J E, Eliseo R, Convery K, Wood W C. Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma. Cancer. 1991; 67 1504-1508
- 70 Law W L, Chu K W, Choi H K. Total pelvic exenteration for locally advanced rectal cancer. J Am Coll Surg. 2000; 190 78-83
- 71 Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T. Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum. 2002; 45 1078-1084
- 72 Kecmanovic D M, Pavlov M J, Kovacevic P A, Sepetkovski A V, Ceranic M S, Stamenkovic A B. Management of advanced pelvic cancer by exenteration. Eur J Surg Oncol. 2003; 29 743-746
- 73 Gunderson L L, Nelson H, Martenson J A et al.. Locally advanced primary colorectal cancer: intraoperative electron and external beam irradiation + / - 5-FU. Int J Radiat Oncol Biol Phys. 1997; 37 601-614
- 74 Hashiguchi Y, Sekine T, Sakamoto H et al.. Intraoperative irradiation after surgery for locally recurrent rectal cancer. Dis Colon Rectum. 1999; 42 886-893 discussion 893-895
- 75 Rodriguez-Bigas M A, Herrera L, Petrelli N J. Surgery for recurrent rectal adenocarcinoma in the presence of hydronephrosis. Am J Surg. 1992; 164 18-21
- 76 Temple W J, Saettler E B. Locally recurrent rectal cancer: role of composite resection of extensive pelvic tumors with strategies for minimizing risk of recurrence. J Surg Oncol. 2000; 73 47-58
- 77 van den Brink M, Stiggelbout A M, van den Hout W B et al.. Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. J Clin Oncol. 2004; 22 3958-3964
- 78 Valentini V, Morganti A G, Gambacorta M A et al.. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study. Int J Radiat Oncol Biol Phys. 2006; 64 1129-1139
- 79 Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. Cancer. 1948; 1 177-183
- 80 Govindarajan A, Coburn N G, Kiss A, Rabeneck L, Smith A J, Law C H. Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst. 2006; 98 1474-1481
- 81 Vermaas M, Ferenschild F T, Verhoef C et al.. Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. Eur J Surg Oncol. 2007; 33(4) 452-458
- 82 Wiig J N, Poulsen J P, Larsen S, Braendengen M, Waehre H, Giercksky K E. Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer. Eur J Surg. 2002; 168 42-48
- 83 Luna-Perez P, Delgado S, Labastida S, Ortiz N, Rodriguez D, Herrera L. Patterns of recurrence following pelvic exenteration and external radiotherapy for locally advanced primary rectal adenocarcinoma. Ann Surg Oncol. 1996; 3 526-533
- 84 Chan A K, Wong A O, Langevin J et al.. Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study. Int J Radiat Oncol Biol Phys. 2000; 48 843-856
- 85 Ike H, Shimada H, Yamaguchi S, Ichikawa Y, Fujii S, Ohki S. Outcome of total pelvic exenteration for primary rectal cancer. Dis Colon Rectum. 2003; 46 474-480
- 86 Chen H S, Sheen-Chen S M. Total pelvic exenteration for primary local advanced colorectal cancer. World J Surg. 2001; 25 1546-1549
- 87 Kakuda J T, Lamont J P, Chu D Z, Paz I B. The role of pelvic exenteration in the management of recurrent rectal cancer. Am J Surg. 2003; 186 660-664
- 88 Ike H, Shimada H, Ohki S, Yamaguchi S, Ichikawa Y, Fujii S. Outcome of total pelvic exenteration for locally recurrent rectal cancer. Hepatogastroenterology. 2003; 50 700-703
- 89 Rutten H J, Mannaerts G H, Martijn H, Wiggers T. Intraoperative radiotherapy for locally recurrent rectal cancer in The Netherlands. Eur J Surg Oncol. 2000; 26 Suppl A S16-S20
- 90 Lopez M J, Barrios L. Evolution of pelvic exenteration. Surg Oncol Clin N Am. 2005; 14 587-606, vii
- 91 Lopez M J, Standiford S B, Skibba J L. Total pelvic exenteration. A 50-year experience at the Ellis Fischel Cancer Center. Arch Surg. 1994; 129 390-395 discussion 395-396
- 92 Marijnen C A, Kapiteijn E, van de Velde C J et al.. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2002; 20 817-825
- 93 Shirouzu K, Isomoto H, Kakegawa T. Total pelvic exenteration for locally advanced colorectal carcinoma. Br J Surg. 1996; 83 32-35
- 94 Wanebo H J, Koness R J, Vezeridis M P, Cohen S I, Wrobleski D E. Pelvic resection of recurrent rectal cancer. Ann Surg. 1994; 220 586-595 discussion 595-397
- 95 Wanebo H J, Gaker D L, Whitehill R, Morgan R F, Constable W C. Pelvic recurrence of rectal cancer. Options for curative resection. Ann Surg. 1987; 205 482-495
- 96 Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer. Surg Oncol Clin N Am. 2005; 14 225-238
- 97 Lopez M J, Luna-Perez P. Composite pelvic exenteration: is it worthwhile?. Ann Surg Oncol. 2004; 11 27-33
- 98 Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum. 2004; 47 2047-2053 discussion 2053-2054
- 99 Hay J M, Fingerhut A, Paquet J C, Flamant Y. Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: a prospective multicenter study. The French Association for Surgical Research. Eur J Surg. 1997; 163 199-206
- 100 O'Leary D P. Use of the greater omentum in colorectal surgery. Dis Colon Rectum. 1999; 42 533-539
- 101 Nilsson P J. Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach. Dis Colon Rectum. 2006; 49 1354-1361
- 102 Kusiak J F. Considerations for reconstruction after surgery for recurrent cancer. Semin Oncol. 1993; 20 430-445
- 103 Vermaas M, Ferenschild F T, Hofer S O, Verhoef C, Eggermont A M, de Wilt J H. Primary and secondary reconstruction after surgery of the irradiated pelvis using a gracilis muscle flap transposition. Eur J Surg Oncol. 2005; 31 1000-1005
- 104 Butler C E, Rodriguez-Bigas M A. Pelvic reconstruction after abdominoperineal resection: is it worthwhile?. Ann Surg Oncol. 2005; 12 91-94
- 105 Chessin D B, Hartley J, Cohen A M et al.. Rectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: a cohort study. Ann Surg Oncol. 2005; 12 104-110
- 106 Ferenschild F T, Vermaas M, Hofer S O, Verhoef C, Eggermont A M, de Wilt J H. Salvage abdominoperineal resection and perineal wound healing in local recurrent or persistent anal cancer. World J Surg. 2005; 29 1452-1457
- 107 Azinovic I, Calvo F A, Puebla F, Aristu J, Martinez-Monge R. Long-term normal tissue effects of intraoperative electron radiation therapy (IOERT): late sequelae, tumor recurrence, and second malignancies. Int J Radiat Oncol Biol Phys. 2001; 49 597-604
- 108 Nuyttens J J, Kolkman-Deurloo I K, Vermaas M et al.. High-dose-rate intraoperative radiotherapy for close or positive margins in patients with locally advanced or recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 2004; 58 106-112
- 109 Gunderson L L, O'Connell M J, Dozois R R. The role of intra-operative irradiation in locally advanced primary and recurrent rectal adenocarcinoma. World J Surg. 1992; 16 495-501
- 110 Kim H K, Jessup J M, Beard C J et al.. Locally advanced rectal carcinoma: pelvic control and morbidity following preoperative radiation therapy, resection, and intraoperative radiation therapy. Int J Radiat Oncol Biol Phys. 1997; 38 777-783
- 111 Willett C G. Intraoperative radiation therapy. Int J Clin Oncol. 2001; 6 209-214
- 112 Wibe A, Eriksen M T, Syse A, Tretli S, Myrvold H E, Soreide O. Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national level. Br J Surg. 2005; 92 217-224
- 113 Schrag D, Panageas K S, Riedel E et al.. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg. 2002; 236 583-592
- 114 Begg C B, Cramer L D, Hoskins W J, Brennan M F. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998; 280 1747-1751
- 115 Jimenez R E, Shoup M, Cohen A M, Paty P B, Guillem J, Wong W D. Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum. 2003; 46 1619-1625
Johannes H. W de WiltM.D. Ph.D.
Department of Surgical Oncology, Erasmus MC - Daniel den Hoed Cancer Center
P.O. Box 5201 3008 AE, Rotterdam, The Netherlands
Email: j.h.w.dewilt@erasmusmc.nl