Outcomes of Salvage Surgery for Cure in Patients With Locally Recurrent Disease After Local Excision of Rectal Cancer

@article{Bikhchandani2015OutcomesOS,
  title={Outcomes of Salvage Surgery for Cure in Patients With Locally Recurrent Disease After Local Excision of Rectal Cancer},
  author={Jai Bikhchandani and Gabie KB. Ong and Eric J. Dozois and Kellie L. Mathis},
  journal={Diseases of the Colon \& Rectum},
  year={2015},
  volume={58},
  pages={283–287}
}
BACKGROUND: Local excision for early rectal cancer has gained widespread interest. Currently available imaging modalities have low sensitivity to detect locoregional disease, which may result in understaging and a high risk of recurrence after local excision. OBJECTIVE: The purpose of this work was to study the morbidity, mortality, and long-term oncologic outcomes in a select cohort of patients undergoing salvage surgery for local recurrence after local excision of early rectal cancer. DESIGN… 
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37 Citations
Background Citations
6
Results Citations
2

37 Citations

Citation Type

Citation Type

Locally Excised T1 Rectal Cancers: Need for Specialized Surveillance Protocols.
TLDR
Locally excised T1 rectal cancers should have specific surveillance guidelines distinct from stage I cancers treated with total mesorectal excision and these guidelines should incorporate a method of local surveillance that should be extended beyond the traditional 5-year interval of surveillance.
Outcomes following completion and salvage surgery for early rectal cancer: A systematic review.
Salvage Surgery After TAMIS Excision of Early-Stage Rectal Cancer
  • S. Hoang, C. Friel
  • Medicine
    Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME)
  • 2019
TLDR
T careful patient selection and aggressive surveillance should be implemented in patients who undergo local excision for early rectal cancer, as well as immediate salvage surgery in this situation, which results in equivalent survival rates to upfront radical resection.
Adjuvant radiotherapy after local excision of rectal cancer
TLDR
The current state of knowledge regarding adjuvant radiotherapy after local excision suggests a potential role in decreasing the risk of local recurrence but further studies are required to better define this effect, clarify which patients will gain the most benefit from this pathway, and identify those who should avoid exposure to the risks of radiotherapy.
Colorectal Cancer: Management of Local Recurrence
TLDR
Improved surgical technique and the appropriate use of chemotherapy and radiation have led to increasingly better oncologic outcomes over the past 20 years, but postoperative morbidity remains high in patients with local recurrence and negatively impacts their quality of life.
Local excision following chemoradiotherapy in T2–T3 rectal cancer: current status and critical appraisal
TLDR
A review of the available literature on this topic was conducted to define the state of the art of this conservative approach and to focus on the most controversial aspects concerning local excision performed after chemoradiotherapy, in particular tumor scatter and lymph node status, completion and salvage surgery, morbidity and quality of life.
Long-term Transanal Excision Outcomes in Patients With T1 Rectal Cancer: Comparative Analysis of Radical Resection
TLDR
Although long-term survival after TAE was comparable to that after TME, TAE had a greater recurrence risk than TME and should only be considered as an alternative surgical option for early rectal cancer in selected patients.
Long-term Oncologic Outcome After Transanal Endoscopic Microsurgery for Rectal Carcinoma
TLDR
The high cancer-specific survival justifies transanal endoscopic microsurgery alone as curative treatment in low-risk rectal carcinoma and restricts the use of TEM alone as compromise therapy, according to a retrospective review of prospectively collected data.
Are we doing too much?: local excision before radical surgery in early rectal cancer
TLDR
The clinical T stage was overestimated in more than half of the cases and if cT1/2 tumors with cN0 are suspected preoperatively, local excision is initially recommended and will allow for determination of underlying pathology.
Local Excision: Indications and Techniques
TLDR
Careful preoperative staging, patient selection, and multidisciplinary team and patient input is vital for using local excision as curative therapy in appropriate patients.
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References

SHOWING 1-10 OF 21 REFERENCES
Multimodality Salvage of Recurrent Disease After Local Excision for Rectal Cancer
TLDR
Failure after local excision for rectal cancer may not be salvageable and multimodality treatment, including multivisceral resection, pelvic irradiation, and chemotherapy, was associated with potentially lasting treatment-related morbidities and only modest success in long-term disease control.
Long-Term Results of Local Excision for Rectal Cancer
TLDR
Neither adjuvant radiotherapy nor salvage surgery was reliable in preventing or controlling local recurrence in patients treated by local excision of T1 and T2 rectal cancers.
Recurrence After Transanal Excision of T1 Rectal Cancer: Should We Be Concerned?
TLDR
Although overall cancer survival rates might be regarded as satisfactory, this high recurrence and low salvage rate raises the issue about the role of transanal excision alone for early rectal cancer and the possible need for adjuvant therapy or increased role of resective surgery.
Surgical Salvage of Recurrent Rectal Cancer After Transanal Excision
TLDR
Pelvic recurrence following transanal excision of early rectal cancer is often locally advanced, requiring an extended pelvic dissection with en bloc resection of adjacent pelvic organs to achieve salvage.
T1 Adenocarcinoma of the Rectum: Transanal Excision or Radical Surgery?
TLDR
It is concluded that today there is a preference for local excision in older patients in whom radical surgery may be associated with a high risk of complications and death, and local excison in younger and fit patients should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence.
Long-Term Survival After Transanal Excision of T1 Rectal Cancer
TLDR
Transanal excision offers inferior oncologic results, including greater risk of cancer-related death, and should be restricted to patients who have prohibitive medical contraindications to major surgery or have made an informed decision to accept the oncological risks of local excision and avoid the functional consequences of rectal resection.
Local excision: is it an adequate substitute for radical resection in T1/T2 patients?
  • Y. You
  • Medicine
    Seminars in radiation oncology
  • 2011
Practice patterns and long-term survival for early-stage rectal cancer.
PURPOSE Standard of care treatment for most stage I rectal cancers is total mesorectal excision (TME). Given the morbidity associated with TME, local excision (LE) for early-stage rectal cancer has…
Is the Increasing Rate of Local Excision for Stage I Rectal Cancer in the United States Justified?: A Nationwide Cohort Study From the National Cancer Database
TLDR
This study provides the best evidence for both the increasing use and the associated risks of LE versus SR and warns that for each individual patient, the benefits of LE must be balanced against the heightened risk of local failure.
A Phase II Trial of Neoadjuvant Chemoradiation and Local Excision for T2N0 Rectal Cancer: Preliminary Results of the ACOSOG Z6041 Trial
TLDR
CRT before LE for T2N0 tumors results in a high pathologic complete response rate and negative resection margins, however, complications during CRT and after LE are high.
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