BOSTONDespite the pessimism of many experts, patients can
benefit from surgery for locoregional recurrence of colorectal
cancer, according to a 12-year retrospective study presented by Julio
Garcia-Aguilar, MD, PhD, at the American Society of Colon and Rectal
Surgeons (ASCRS) annual meeting.
Patients treated aggressively had better 5-year survival rates and
quality of life than those who only received palliative care, he told ONI
in a postconference interview. Two thirds of the patients did not
have another locoregional recurrence.
Some people would say surgery to remove the recurrence is not a
good idea because the chance of curing the patient is small, he
said. But the patients who had curative resection had a better
5-year-survival rate both for colon cancer and rectal cancer.
Dr. Garcia-Aguilar is clinical associate professor of surgery,
Division of Colon and Rectal Surgery, University of Minnesota Medical
School and Cancer Center, Minneapolis. He and his colleagues take an
aggressive approach to locore-gional recurrences, he said, and
decided to review their own experience because of widespread
pessimism among other surgeons.
They reviewed the charts of 2,090 colorectal cancer patients who had
radical resections with curative intent between January 1987 and
April 1999. There were 1,160 patients with colon cancer and 930 with
rectal cancer. Of this group, 101 patients had a recurrence in the
surgical bed with no other sign of disease.
Curative resections were performed on 21 patients with recurring
colon cancer and 30 with recurring rectal cancer. The cancer was
considered unresectable or was resected leaving residual tumor in
another 18 patients. Resection was not attempted in the remaining 32 patients.
Among those who had curative salvage surgery, the mean 5-year
survival rate was 52% for colon cancer patients and 44% for rectal
cancer patients. Among those treated palliatively, the mean 5-year
survival rate was much lower: 21% for colon cancer patients and 17%
for rectal cancer patients.
Dr. Garcia-Aguilar anticipates that the study will be challenged
because the patients who could not be resected probably had more
advanced recurrence than those who had a second resection. The
argument is that we are selecting for resection the tumors that will
do better anyway, he said.
The benefits from the surgical resection of the locoregional
recurrence should not be measured only in terms of long-term
survival, Dr. Garcia-Aguilar countered. Uncontrolled locoregional
recurrences cause significant pain and complications.
He said that curative resection not only represents the only hope for
cure but also eliminates some of the complications from the disease.
In the retrospective study, he noted, patients who could not be
resected were more likely to develop bowel obstruction, probably as a
result of progression of their tumors.
Few patients survive long term; the number is not very
high, Dr. Garcia-Aguilar said. But even with patients who
eventually die from the disease, removing the tumor makes their life
more comfortable. It improves the quality of life.