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2010 Annual Meeting Abstracts

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Posterior Pelvic Resection of Recurrent Rectal Cancer has Survival Benefit in over 30% of Patients, but Outcome is Governed by Strategic Tumor Biologic Factors
Harold J Wanebo1, *Giovanni Begossi2, *James Belliveau1
1Landmark Medical Center, Woonsocket, RI;2Roswell Park Cancer Institute, Buffalo, NY

Introduction: Pelvic recurrence of rectal cancer presents a formidable problem for patient and surgeon. Background: Although improvements with total mesorectal excision coupled with neoadjuvant/adjuvant therapy has significantly improved outcome, local failure is still an ominous event especially in the irradiated pelvis. We have updated our series of curative abdominosacral resection (ABSR) for advanced and recurrent rectal cancer (63-recurrence, 5-primary tumor) involving musculoskeletal pelvis. Survival was analyzed by Kaplan-Meir method. Regression analysis compared selected prognosticators: preoperative CEA level, age, gender, initial stage and surgery, disease free period and adequacy of ABSR (R0 vs. R1 resection). Results: Periopoerative mortality at 60 days was 6% (4 pts). All pts encountered various medical/surgical complications. Overall (OS) and disease free (DFS) and median survivals were (30%/20%) 32/18 months respectively; 17 pts (25%) were surviving 60-249 mos. There were no significant outcome correlations with age, gender, primary stage or disease free interval (DFI) , or residual disease post ABSR (RO resection, 49 pts, R1 resection 10 pts, Disease involved marrow (5 pts), margin (5pts) +/- LN 4pt.
Disease Related Correlations:
Number of
Patients
5Y KM
Overall
5Y KM
Dis-Free
Log-Rank/
Regression
Overall5930%20%
CEA <5ng/ml
CEA >5ng/ml
25
32
47%
16%
28%
15%
0.02/0.04
After APR
After AR
33
24
20%
35%
13%
21%
0.03/ns
DFI mos- APR
AR
32 (21mos)
24 (23mos)
NS
Primary /Stage I/II
Primary/Stage III
27
24
34%
23%
13%
23%
Ns/ns
Resection
R0
R1
49
10
35%/32m
0%/21m
20%
0%
Ns(x²)

Conclusion: ABSR for pelvic recurrence provides opportunity for long-term survival with 5y OS/DFS of 30%/20% respectively. Prognostic factors affecting survival were type of primary surgery (APR vs. AR), and CEA level (</> 5ng/ml). Patient selection based on clinical and radiologic staging coupled with adjuvant therapy protocols may enhance survival in this high-risk group.


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