In a large single-center analysis reported in the Journal of Clinical Oncology, Ikoma et al found that salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence but not in those with locoregional-only recurrence after preoperative chemotherapy and total mesorectal excision of locally advanced rectal cancer.
The study involved data from 735 patients with locally advanced (cT3–4 or cN+) rectal cancer treated with preoperative chemoradiotherapy followed by total mesorectal excision at MD Anderson Cancer Center between 1993 to 2008. Tumors were predominantly mid-rectal to lower rectal cancer, with a median distance from the anal verge of 5 cm.
Median follow-up time was 96 months. Recurrence was observed in 21% of patients; of them, 85% had single-site recurrence. Among all patients, the most common sites of recurrence were the lungs (9.6%), liver (5.9%), and locoregional sites (5.1%). Median time to recurrence was shorter with liver-only recurrence (11.2 months) vs lung-only recurrence (18.2 months) and locoregional-only recurrence (24.7 months; P = .001).
Salvage Surgery and Survival
A total of 64 of 113 patients (56.6%) with single-site recurrence at the liver, lungs, or locoregional sites underwent salvage surgery. Overall, salvage surgery was associated with significantly longer overall survival vs no salvage surgery (estimated median survival after recurrence = 5.1 vs 2.3 years, 5-year survival = 51% vs 13%; P < .001). Median survival was 5.1 years and 5.3 years in patients with salvage surgery for lung-only and liver-only recurrence (P = .39), with adjusted hazard ratios vs no salvage therapy of 0.25 (P < .001) and 0.17 (P = .008). Among patients with locoregional recurrence-only recurrence, median overall survival was 3.6 years with vs 3.2 years without surgery (P = .353).
The authors concluded: “We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.”
The study was supported by the National Institutes of Health and the Aman Trust for Colorectal Cancer Research and Education.
George J. Chang, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
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