Risk factors and treatment strategies for local recurrence of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by total mesorectal excision

Seijong Kim; Jung Wook Huh; Woo Yong Lee; Seong Hyeon Yun; Hee Cheol Kim; Yong Beom Cho; Yoonah Park; Jung Kyong Shin

doi:10.1016/j.ejso.2024.108641

Risk factors and treatment strategies for local recurrence of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by total mesorectal excision

Eur J Surg Oncol. 2024 Aug 24;50(11):108641. doi: 10.1016/j.ejso.2024.108641. Online ahead of print.

Authors

Seijong Kim¹, Jung Wook Huh², Woo Yong Lee¹, Seong Hyeon Yun¹, Hee Cheol Kim¹, Yong Beom Cho¹, Yoonah Park¹, Jung Kyong Shin¹

Affiliations

¹ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
² Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jungwook.huh@gmail.com.

PMID: 39213693
DOI: 10.1016/j.ejso.2024.108641

Abstract

Background: Despite advancements in total mesorectal excision (TME) and neoadjuvant radiotherapy, locally advanced rectal cancer remains challenging, impacting patient quality of life and mortality. This study aimed to identify the risk factors for local recurrence in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) and assess treatment strategies for recurrence.

Methods: This retrospective analysis included 682 patients diagnosed with locally advanced rectal cancer who were treated with neoadjuvant CRT and TME at Samsung Medical Center from 2008 to 2017. The exclusion criteria ensured a homogenous cohort. Clinical staging involved colonoscopies, computed tomography, magnetic resonance imaging, and digital rectal exam. Risk factors, treatment modalities, and oncological outcomes for local recurrence were evaluated.

Result: During a median 62-month follow-up, 47 patients (6.9 %) experienced local recurrence. The risk factors for local recurrence included a positive circumferential resection margin (CRM), venous invasion, and perineural invasion. Of the 47 patients with local recurrence, 25 (53.2 %) were considered resectable. Out of these, 23 patients underwent curative resections, and 15 (65.2 %) achieved R0 resection. Patients with R0 resections exhibited superior 5-year survival rates compared to R1-2 resection or non-surgical treatment, and there was no survival difference between R1-2 resection and non-surgical treatment.

Conclusion: In locally advanced rectal cancer, positive CRM, venous invasion, and perineural invasion were associated with local recurrence. R0 resection showed favorable outcomes, emphasizing the importance of surveillance in high-risk patients. Treatment decisions should consider these factors for improved oncologic outcomes and quality of life.

Keywords: Local recurrence; Rectal cancer; Survival.