Progress in the treatment of locally recurrent rectal cancer / 中国肿瘤临床

The treatment of locally recurrent rectal cancer (LRRC) is multidisciplinary, including surgery, external beam radiotherapy, intraoperative radiotherapy, radioactive seed implantation, hyperthermia therapy, radiofrequency ablation, etc. Nevertheless, the predominant treatments are surgery and radiotherapy. Complete resection (R0 resection) is an independent prognostic factor. With the advent of intensity modulated radiation therapy (IMRT) and stereotactic body radiotherapy (SBRT), the efficacy of re-irradiation for patients who have previously received radiotherapy is confirmed, and the side effects are acceptable. Moreover, with the development of more treatment modalities, the survival rate and local control rate of patients are increasing, and the quality of life is improved. In conclusion, the treatment of LRRC is comprehensive and requires the participation of multidisciplinary physicians. However, proper and effective treatment needs more research evidence. This review summarized the latest progress in the multidisciplinary treatment of LRRC and the unresolved problems.

Ante situm Liver Resection under Total Vascular Exclusion and Venovenous Bypass with Hypothermic Perfusion for Treating a Recurrent Rectal Cancer Liver Metastasis

We present here a case of recurrent rectal cancer liver metastasis that was managed with ante situm liver resection under total vascular exclusion (TVE) and venovenous bypass with hypothermic perfusion. A 58-year-old man who suffered with rectal cancer liver metastasis was transferred to our hospital in January 2006. A left lateral sectionectomy had been previously performed. Recurrent lesion developed in segments I, IV and VIII one year after the first hepatectomy. The tumor was 5 cm in diameter and it involved the confluence of the hepatic veins and the retrohepatic vena cava. An incomplete tumor-free margin and massive bleeding were expected with performing a conventional liver resection, together with vena cava reconstruction. Therefore, we planned an ante situm liver resection under TVE and venovenous bypass with hypothermic perfusion. After adhesiolysis, hilar dissection was carried out. The inflow to the medial segment was interrupted, and then the liver and inferior vena cava (IVC) were mobilized fully. During controlling the bleeding of a short hepatic vein, we found adhesion of the hepatocaval portion. Therefore, TVE and venovenous bypass were performed along with suprahepatic IVC transection. The long conduit of V5 was preserved during hepatic parenchymal dissection, and the paracaval portion of the caudate lobe was readily detached from the IVC. The suprahepatic IVC was reconstructed after V5 reconstruction with using the saphenous vein. Portal vein anastomosis was then conducted. After reperfusion, an end-to-side anastomosis was performed between the saphenous vein graft and the IVC. Finally, a Roux-en-Y hepaticojejunostomy was carried out. The patient remains well without recurrence 12 months after the last operation.

The Rectus Abdominis Myocutaneous Flap for the Immediate Reconstruction of Partial Vaginal Defects Following the Extended Abdominoperineal Resection of Recurrent Rectal Cancer

Extensive resection including posterior vaginal wall may be required for the advanced low rectal cancer or recurrent rectal cancer in order to achieve the tumor free circumferential margins. We describe closure of a vaginal defect with rectus abdominis musculocutaneous flap after extended abdominoperineal resection, hysterectomy and partial colpectomy in a patient with recurrent rectal cancer with the special reference to the surgical technique.

Pelvic Exenteration as the Treatment for Recurrent or Locally Advanced Rectal Cancer

PURPOSE: The purpose of this study is to evaluate the value of pelvic exenteration (PE) for recurrent or locally advanced rectal cancer. METHODS: This retrospective study analyzed 20 patients who underwent PE for rectal cancer from June 1994 to October 2003 in Ajou University Hospital. The surgical severity, the postoperative complications, and the survival rate were analyed based on the medical records. RESULTS: The mean operation time was 221.5+/-93.0 minutes, the mean blood loss 750.5+/-223.3 cc, and the mean transfusion amount RBC 6.5+/-4.3 units. Operative mortality was 5% (1/20). A bleeding-associated complication was noted in one patient who underwent a reoperation for hemostasis. Other minor complications were small bowel obstruction (n=3), abdominal wound infection (n=5), vesicocutaneous fistula (n=2), delayed healing of the perineal wound (n=10). The overall 5-year survival rate was 52.6% (10 of 19 patients, excluding the operative mortality case). CONCLUSIONS: Our study showed acceptable surgical severity and postoperative complications and a favorable 5-year survival rate (> or =50%) for pelvic exenteration as a treatment for recurrent or locally advanced rectal cancer. With strictly selected patients, PE may be one of the treatment options for recurrent or locally advanced rectal cancer.

Intracavitary Irradiation of Locally Advanced Recurrent Adenocarcinoma of Rectum Along the Fistula tract / 대한치료방사선과학회지

Radiation therapy has been used as adjuvant therapy or primary treatment for inoperable, remnant or recurrent cancer. Many authors reported good palliation effect by external irradiation or interstitial therapy, but the report of intracavitary irradiation for recurrent, inoperable rectal cancer is very rare. We experienced a case of recurrent adenocarcinoma of rectum along fistula tract after laparotomy and postoperative radiotherapy who achieved very good palliation by intracavitary irradiation. Even though we have only good palliation without impressive survival improvement in this case, we hope that this technique may achieve good local control in other similar patients.

Residual, Unresectable and Recurrent Rectal Cancer: Role of External Radiation Therapy in 46 Patients / 대한치료방사선과학회지

Fifty patients with residual, unresectable or recurrent rectal cancer were treated with external irradiation using a 6-MV linear accelerator at the Division of Therapeutic Radiology, Department of Radiology, Kangnam St. Mart's Hospital, Catholic University Medical College during the period of April 1983 to December 1987. This paper describes the results of a retrospective analysis of the results of external irradiation for the residual, unresectabel and recurrent rectal cancer in 46 patients. Four patients were lost to follow-up. Of the 46 patients, 18(39%) presented with unresectable primary lesions and 28 (61%) with residual or recurrent rectal cancer. In 93%, the pathologic diagnosis was adenocarcinoma. Resonse to irradiation was observed in 22 (73%) out of 30 patients who were treated for pain, 12 (86%) out of 14 patients who were treated for mass, and 17 (77%) out of 22 patients who were treated for bloody discharge. The actuarial postoperative 2-year and 3-year survival rates in recurrent and unresectable patients were 43% and 22%, respectively. However, the post-RT 2-year survival rate was 13% (6/46).