Early and Late Outcomes of Surgery for Locally Recurrent Rectal Cancer: A Prospective 10-Year Study in the Total Mesorectal Excision Era

The aim of this study was to assess the outcome of all locally recurrent rectal cancer (LRRC) patients who were referred to a tertiary care center. The study examined LRRC patients who underwent surgery after prior total mesorectal excision. The data of 213 consecutive LRRC patients who were registered in a database between 2001 and 2010 were accessed. A total of 115 patients (54 %) with a median age of 63 (range 34-81) years underwent tumor resection. The 30-day mortality rate was 0.8 % (95 % CI 0.02-4 %), and the complication rate was 42 % (95 % CI 33-51 %). R0 resection was achieved in 70 patients (61 %), R1 resection in 38 patients (33 %), and R2 resection in 7 patients (6 %). The 3- and 5-year survival rates for R0 resections were 55 % (95 % CI 41-66) and 40 % (95 % CI 26-53), respectively; 42 % (95 % CI 26-58) and 16 % (95 % CI 5-31), respectively, for R1 resections; no patients who received an R2 resection survived to the 3-year mark. Patients with prior abdominoperineal excision (APE) had significantly poorer survival rates than patients with prior resection with anastomosis (p = 0.02). Acceptable long-term survival can be achieved for patients undergoing surgery for LRRC, but radical resection is mandatory. Prior APE was associated with poorer survival rates.