Surgery Supported for Recurring Colorectal Cancer

BOSTON—Despite 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.”