Outcomes of salvage surgery for cure in patients with locally recurrent disease after local excision of rectal cancer.

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 A retrospective review of patient charts was used to determine patterns of disease recurrence and outcomes as a single-institution case series. SETTINGS The study was conducted at a tertiary care cancer center. PATIENTS The study cohort included patients with early rectal cancer treated by local excision who then developed local recurrence for which a multimodal salvage surgery with curative intent was performed between 1997 and 2013 at our center. MAIN OUTCOME MEASURES Log rank tests were used to measure overall and disease-free survival. RESULTS Twenty-seven patients were identified, with a mean age of 66 ± 12 years. The median time to recurrence was 54 weeks (range, 7-326 weeks). Recurrent disease was luminal in 23 patients, regional (involving both mesorectal and pelvic lymph nodes) in 6 patients, and both luminal and nodal in 2 patients. For salvage surgery, neoadjuvant chemoradiation was used in 12 patients (44%), and radiation alone was used in 1 patient. Sphincter-preserving surgery was performed in 9 patients (33%). R0 resection was achieved in 25 patients (93%). Four patients received intraoperative radiation therapy. Five-year overall survival was 50% (95% CI, 30%-74%), and re-recurrence-free survival was 47% (95% CI, 25%-68%). LIMITATIONS This study was limited by its retrospective nature, small patient cohort, referral bias, and selection bias. CONCLUSIONS Even in highly selected patients who undergo surgery for local recurrence after transanal excision of early stage rectal cancer, oncologic outcomes are poor.