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A Population-Based Study on the Management and Outcome in Patients with Locally Recurrent Rectal Cancer

Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden

Correspondence: Address correspondence and reprint requests to: G. Palmer, MD, Section of Coloproctology, Department of Surgery, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden; E-mail: gabriella.jansson-palmer{at}karolinska.se

Background: Although outcome in patients with rectal cancer has improved with preoperative radiotherapy and total mesorectal excision, local recurrence still remains a problem. The condition is difficult to cure and little is known on whether the prognosis for patients with locally recurrent tumours has changed over time. Few population-based studies have been performed.

Method: Two thousand three hundred and eighteen patients in Stockholm, Sweden had a potentially curative resection for rectal cancer between 1995 and 2003. Until 2005, 141 (6%) developed a local recurrence. Management and outcome for these patients were studied and compared to a previously analysed cohort of 156 patients with local recurrence, treated 1980–1991.

Results: Of the 141 patients, 57 (40%) had surgery with a curative intent, 48 (34%) radio-and/or chemotherapy and 36 (26%) symptomatic palliation only. The total 5-year survival was 9%. Twenty-five patients had a potentially curative resection, with a 5-year survival of 57%. The corresponding figures for the 156 patients in the earlier cohort were 4 and 42%.

Conclusion: Although outcome for patients with local recurrence of rectal cancer is dismal, the prognosis has improved slightly over time. A radical resection is a prerequisite for cure and the proportion having a potentially curative resection has increased. Multidisciplinary management, including optimised preoperative staging and patient selection for surgery, radical surgical approach and more effective adjuvant treatments are necessary to further improve the prognosis.

Key Words: Locally recurrent rectal cancer • Treatment • Outcome • Survival • Re-recurrence