Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum:Clinicopathologic correlation and implications for adjuvant therapy

TLDR

Postoperative irradiation may be a logical adjuvant in view of the high percentage of local‑regional failures and the ability to identify subgroups of patients at highest risk for such failure. Seventy‑five high‑risk rectal cancer patients underwent planned reoperations at the University of Minnesota, and the authors analyzed areas of failure in detail. Among the 75 patients, 52 had tumor recurrence, four became disease‑free, distant metastasis alone was uncommon, peritoneal seeding rare, and local or regional failures occurred alone in nearly half and as part of the pattern in 92 % of cases, indicating predictable failure patterns based on anatomy and initial pathology.

Abstract

Seventy-five patients with complete bowel wall penetration and/or positive lymph nodes at the time of initial "curative surgery" had planned single or multiple reoperations at the University of Minnesota. Tumor due to rectal carcinoma was found in 52. Four were converted to disease-free status. Areas of failure were analyzed in detail. Distant metastasis (DM) alone was uncommon. Peritoneal seeding (PS) was rare. Local failure and/or regional lymph node metastases (LF-RF) occurred as the only failure in nearly 50% of the failure group and as some component in 92%. Patterns of failure are fairly predictable if anatomical factors and initial pathologic extent of tumor are considered. Postoperative irradiation may be a logical adjuvant in view of the high percentage of local-regional failures and the ability to identify subgroups of patients at highest risk for such failure.