Novel and Innovative Surgical Strategies for Recurrent Rectal Cancer: Uncommon Resections, Local Interventions for Pelvic Reoccurrence, and Intraoperative Radiation Therapy

Abstract

The frequency of recurrent rectal cancer has dropped significantly with improved surgical approaches and adjunctive therapies. These recurrences have proven challenging to obtain R0 resection with salvage operations. Meticulous planning, clear understanding of anatomy with imaging, and multispecialty support have become essential in local control and long-term survival with pelvic recurrence of rectal cancer. Technical considerations and prognosis indicators along with role of intraoperative radiation or boost radiation are discussed within.

Keywords

recurrent rectal cancer - colon and rectal surgery

Publication History

Article published online:
24 March 2023

• References

• 1 Kapiteijn E, Marijnen CA, Nagtegaal ID. et al; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345 (09) 638-646
• 2 Nielsen MB, Laurberg S, Holm T. Current management of locally recurrent rectal cancer. Colorectal Dis 2011; 13 (07) 732-742
• 3 Bouchard P, Efron J. Management of recurrent rectal cancer. Ann Surg Oncol 2010; 17 (05) 1343-1356
• 4 Kim YW, Kim NK, Min BS. et al. Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol 2009; 99 (01) 58-64
• 5 Moore HG, Shoup M, Riedel E. et al. Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum 2004; 47 (10) 1599-1606
• 6 Wanebo HJ, Antoniuk P, Koness RJ. et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 1999; 42 (11) 1438-1448
• 7 Hahnloser D, Nelson H, Gunderson LL. et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003; 237 (04) 502-508
• 8 Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 2007; 14 (02) 447-454
• 9 Valentini V, Morganti AG, Gambacorta MA. et al; Study Group for Therapies of Rectal Malignancies (STORM). 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 (04) 1129-1139
• 10 Lindel K, Willett CG, Shellito PC. et al. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol 2001; 58 (01) 83-87
• 11 Heriot AG, Byrne CM, Lee P. et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum 2008; 51 (03) 284-291
• 12 Saito N, Koda K, Takiguchi N. et al. Surgery for local pelvic recurrence after resection of rectal cancer. Int J Colorectal Dis 1998; 13 (01) 32-38
• 13 Colibaseanu DT, Mathis KL, Abdelsattar ZM, Larson DW, Haddock MG, Dozois EJ. Is curative resection and long-term survival possible for locally re-recurrent colorectal cancer in the pelvis?. Dis Colon Rectum 2013; 56 (01) 14-19
• 14 Lee DJ-K, Sagar PM, Sadadcharam G, Tan KY. Advances in surgical management for locally recurrent rectal cancer: how far have we come?. World J Gastroenterol 2017; 23 (23) 4170-4180
• 15 Marzouk O, Schofield J. Review of histopathological and molecular prognostic features in colorectal cancer. Cancers (Basel) 2011; 3 (02) 2767-2810
• 16 Mirnezami AH, Sagar PM. Surgery for recurrent rectal cancer: technical notes and management of complications. Tech Coloproctol 2010; 14 (03) 209-216
• 17 Dozois EJ, Privitera A, Holubar SD. et al. High sacrectomy for locally recurrent rectal cancer: can long-term survival be achieved?. J Surg Oncol 2011; 103 (02) 105-109
• 18 Milne T, Solomon MJ, Lee P, Young JM, Stalley P, Harrison JD. Assessing the impact of a sacral resection on morbidity and survival after extended radical surgery for locally recurrent rectal cancer. Ann Surg 2013; 258 (06) 1007-1013
• 19 Solomon MJ, Austin KK, Masya L, Lee P. Pubic bone excision and perineal urethrectomy for radical anterior compartment excision during pelvic exenteration. Dis Colon Rectum 2015; 58 (11) 1114-1119
• 20 Beyond TME. Beyond TME Collaborative. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 2013; 100 (08) 1009-1014
• 21 Austin KK, Solomon MJ. Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum 2009; 52 (07) 1223-1233
• 22 Nagasaki T, Akiyoshi T, Ueno M. et al. Laparoscopic salvage surgery for locally recurrent rectal cancer. J Gastrointest Surg 2014; 18 (07) 1319-1326
• 23 Bosset JF, Calais G, Mineur L. et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results--EORTC 22921. J Clin Oncol 2005; 23 (24) 5620-5627
• 24 Mohiuddin M, Marks G, Marks J. Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer 2002; 95 (05) 1144-1150
• 25 Koom WS, Choi Y, Shim SJ. et al. Reirradiation to the pelvis for recurrent rectal cancer. J Surg Oncol 2012; 105 (07) 637-642
• 26 Hashiguchi Y, Sekine T, Kato S. et al. Indicators for surgical resection and intraoperative radiation therapy for pelvic recurrence of colorectal cancer. Dis Colon Rectum 2003; 46 (01) 31-39
• 27 Roeder F, Goetz JM, Habl G. et al. Intraoperative electron radiation therapy (IOERT) in the management of locally recurrent rectal cancer. BMC Cancer 2012; 12: 592
• 28 Gunderson LL, Nelson H, Martenson JA. et al. Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Dis Colon Rectum 1996; 39 (12) 1379-1395
• 29 Henry LR, Sigurdson E, Ross EA. et al. Resection of isolated pelvic recurrences after colorectal surgery: long-term results and predictors of improved clinical outcome. Ann Surg Oncol 2007; 14 (07) 2000-2009