Patterns and outcomes of disease recurrence after pelvic exenteration for locally recurrent rectal cancer
Jennifer K Vu, Kilian G M Brown, Michael J Solomon, Kheng-Seong Ng, Sarah Sutherland, Kate Mahon, Bernard K Le, Kirk K S Austin, Christopher M Byrne, Peter J Lee, Daniel SteffensAbstract
Background
Despite recent improvements in survival after pelvic exenteration for locally recurrent rectal cancer, long-term re-recurrence remains a significant cause of mortality. The aim of this study was to report the patterns and outcomes of recurrence after exenteration and to determine how surgical resection margins and the site of disease recurrence influence survival.
Methods
Consecutive patients who underwent pelvic exenteration for locally recurrent rectal cancer at a high-volume exenteration centre between 1994 and 2023 were included. Clinicopathological and survival data were extracted from a prospective database. Recurrence data were retrospectively collected from patient medical records.
Results
In total, 282 patients were included in the analysis, with a median follow-up of 3.5 years. The R0 resection rate was 81.6% (230 patients). Of the 255 patients with available data, 130 (51.0%) developed recurrence (30 (11.8%), 79 (31.0%), and 21 (8.2%) with only local recurrence, only distant recurrence, and both local and distant recurrence respectively). R0 resection was associated with a lower local recurrence rate versus R1/2 resection (13.9% versus 36.5%; P = 0.001), but a similar distant recurrence rate (36.5% versus 30.8%). The lungs were the most common site of recurrence after R0 resection. The 5-year survival rate was 42.3% for the overall study cohort and 48.0% after R0 resection (versus 17.2% after R1/2 resection; P < 0.001). Local recurrence after exenteration was independently associated with poorer survival (HR 3.84 (95% c.i. 2.24 to 6.57); P < 0.001).
Conclusion
R0 resection margins may be associated with improved survival due to better local control, rather than distant control. The lungs are the most common site of recurrence after curative resection.