Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence

Mamoru Uemura, Masataka Ikeda, Hirofumi Yamamoto, Kotaro Kitani, Masayoshi Tokuoka, Ken Matsuda, Yuki Hata, Tsunekazu Mizushima, Ichiro Takemasa, Mitsugu Sekimoto, Ko Hosokawa, Nariaki Matsuura, Yuichiro Doki, Masaki Mori

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Abstract

Background: Local re-recurrence after R0 resection of local recurrence of rectal cancer (LRRC) is not rare. The purpose of this study was to examine the pathological features of LRRC and determine the prognostic factors. Methods: Twenty-one patients underwent R0 resection of LRRC without preoperative therapy from 2000 to 2008. Tumor progression patterns were classified into three types: A, expanding type; B, infiltrating type; and C, intermediate type. Distant isolated cancer cells (DICCs) were defined as cancer cells present in isolation and at a distance (>1 mm) from the tumor edge. Results: Venous invasion was identified in all but one patient (95%). DICCs were observed in 11 of 21 cases. Type A patients had a significantly lower local re-recurrence rate (0/5) compared with type B and/or C patients (11/16, P = 0.012) and a significantly lower incidence of distant metastasis compared with type B and C patients (0/5 vs. 13/ 16, respectively; P = 0.0028). Multivariate regression analysis identified venous invasion of the primary lesion (P = 0.027) and tumor progression patterns (P = 0.039) as independent predictors of local re-recurrence. Conclusions: The main features of LRRC were infiltrating growth, venous invasion, and DICCs. Tumor progression patterns correlated with local re-recurrence and distant metastasis. Preoperative adjuvant therapy to terminate peritumor cancer cells may be required for better tumor control.

Original languageEnglish
Pages (from-to)1015-1022
Number of pages8
JournalAnnals of Surgical Oncology
Volume18
Issue number4
DOIs
Publication statusPublished - Apr 1 2011
Externally publishedYes

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Rectal Neoplasms
Recurrence
Neoplasms
Neoplasm Metastasis
Multivariate Analysis
Regression Analysis
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence. / Uemura, Mamoru; Ikeda, Masataka; Yamamoto, Hirofumi; Kitani, Kotaro; Tokuoka, Masayoshi; Matsuda, Ken; Hata, Yuki; Mizushima, Tsunekazu; Takemasa, Ichiro; Sekimoto, Mitsugu; Hosokawa, Ko; Matsuura, Nariaki; Doki, Yuichiro; Mori, Masaki.

In: Annals of Surgical Oncology, Vol. 18, No. 4, 01.04.2011, p. 1015-1022.

Research output: Contribution to journalArticle

Uemura, M, Ikeda, M, Yamamoto, H, Kitani, K, Tokuoka, M, Matsuda, K, Hata, Y, Mizushima, T, Takemasa, I, Sekimoto, M, Hosokawa, K, Matsuura, N, Doki, Y & Mori, M 2011, 'Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence', Annals of Surgical Oncology, vol. 18, no. 4, pp. 1015-1022. https://doi.org/10.1245/s10434-010-1435-z
Uemura, Mamoru ; Ikeda, Masataka ; Yamamoto, Hirofumi ; Kitani, Kotaro ; Tokuoka, Masayoshi ; Matsuda, Ken ; Hata, Yuki ; Mizushima, Tsunekazu ; Takemasa, Ichiro ; Sekimoto, Mitsugu ; Hosokawa, Ko ; Matsuura, Nariaki ; Doki, Yuichiro ; Mori, Masaki. / Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 4. pp. 1015-1022.
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AU - Ikeda, Masataka

AU - Yamamoto, Hirofumi

AU - Kitani, Kotaro

AU - Tokuoka, Masayoshi

AU - Matsuda, Ken

AU - Hata, Yuki

AU - Mizushima, Tsunekazu

AU - Takemasa, Ichiro

AU - Sekimoto, Mitsugu

AU - Hosokawa, Ko

AU - Matsuura, Nariaki

AU - Doki, Yuichiro

AU - Mori, Masaki

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N2 - Background: Local re-recurrence after R0 resection of local recurrence of rectal cancer (LRRC) is not rare. The purpose of this study was to examine the pathological features of LRRC and determine the prognostic factors. Methods: Twenty-one patients underwent R0 resection of LRRC without preoperative therapy from 2000 to 2008. Tumor progression patterns were classified into three types: A, expanding type; B, infiltrating type; and C, intermediate type. Distant isolated cancer cells (DICCs) were defined as cancer cells present in isolation and at a distance (>1 mm) from the tumor edge. Results: Venous invasion was identified in all but one patient (95%). DICCs were observed in 11 of 21 cases. Type A patients had a significantly lower local re-recurrence rate (0/5) compared with type B and/or C patients (11/16, P = 0.012) and a significantly lower incidence of distant metastasis compared with type B and C patients (0/5 vs. 13/ 16, respectively; P = 0.0028). Multivariate regression analysis identified venous invasion of the primary lesion (P = 0.027) and tumor progression patterns (P = 0.039) as independent predictors of local re-recurrence. Conclusions: The main features of LRRC were infiltrating growth, venous invasion, and DICCs. Tumor progression patterns correlated with local re-recurrence and distant metastasis. Preoperative adjuvant therapy to terminate peritumor cancer cells may be required for better tumor control.

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