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Henry LR , Sigurdson E , Ross E , Hoffman JP
Hydronephrosis does not preclude curative resection of pelvic recurrences after colorectal surgery
Annals of Surgical Oncology. 2005 ;12(10) :786-792
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Background: In one third of patients who die of rectal cancer, a pelvic recurrence after resection represents isolated disease for which re-resection may provide cure. These extensive resections can carry high morbidity. Proper patient selection is desirable but difficult. Hydronephrosis has been documented previously to portend a poor prognosis, and some consider it a contraindication to attempted resection. It was our goal to review our experience and either confirm or refute these conclusions. Methods: We performed a retrospective analysis of 90 patients resected with curative intent for pelvic recurrence at our center from 1988 through 2003. Seventy-one records documented the preoperative presence or absence of hydronephrosis. Clinical and pathologic data were recorded. The groups with and without hydronephrosis were compared. Results: There were 15 patients with hydronephrosis in this study and 56 without. Although patients with hydronephrosis had shorter overall survival, disease-free survival, and rate of local control, none of these differences was statistically significant. Patients in the hydronephrosis group were younger and had higher-stage primary tumors and larger recurrent tumors. Subsequently, they underwent more extensive resections and were more likely to be treated with adjuvant therapies. There was no difference in the rate of margin-negative resections between the groups. Conclusions: Hydronephrosis correlates with younger patients with larger recurrent tumors undergoing more extensive operations and multimodality therapy but does not preclude curative (R0) resection or independently affect overall survival, disease-free survival, or local control. We believe that it should not be considered a contraindication to attempting curative resection. © 2005 The Society of Surgical Oncology, Inc.
10689265 (ISSN) Cited By: 0; Export Date: 25 May 2006; Source: Scopus CODEN: ASONF; DOI: 10.1245/ASO.2005.10.004 Language of Original Document: English Correspondence Address: Hoffman, J.P.; Department of Surgical Oncology; Fox Chase Cancer Center; 333 Cottman Avenue Philadelphia, PA 19111, United States; email: jp_hoffman@fccc.edu References: Karanjia, N.D., Schache, D.J., North, W.R., Heald, R.J., "Close shave" in anterior resection (1990) Br J Surg, 77, pp. 510-512; Carlsson, U., Lasson, A., Ekel, G., Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy (1987) Dis Colon Rectum, 30, pp. 431-434; Welch, J.P., Donaldson, G.A., The clinical correlation of an autopsy study of recurrent colorectal cancer (1979) Ann Surg, 4, pp. 496-502; Kakuda, J.T., Lamont, J.P., Chu, D.Z.J., Paz, I.B., The role of pelvic exenteration in the management of recurrent rectal cancer (2003) Am J Surg, 186, pp. 660-664; Cheng, C., Rodriguez-Bigas, M.A., Petrelli, N., Is there a role for curative surgery for pelvic recurrence from rectal carcinoma in the presence of hydronephrosis? (2001) Am J Surg, 182, pp. 274-277; Rodriguez-Bigas, M.A., Herrera, L., Petrelli, N.J., Surgery for recurrent rectal adenocarcinoma in the presence of hydronephrosis (1992) Am J Surg, 164, pp. 18-21; Maetani, S., Onodera, H., Nishikawa, T., Significance of local recurrence of rectal cancer as a local or disseminated disease (1998) Br J Surg, 85, pp. 521-525; Garcia-Aguilar, J., Cromwell, J.W., Marra, C., Lee, S.H., Madoff, R.D., Rothenberger, D.A., Treatment of locally recurrent rectal cancer (2001) Dis Colon Rectum, 44, pp. 1743-1748; Lopez-Kostner, F., Fazio, V.W., Vignali, A., Rybicki, L.A., Lavery, I.C., Locally recurrent rectal cancer: Predictors and success of salvage surgery (2001) Dis Colon Rectum, 44, pp. 173-178; Wanebo, H.J., Koness, R.J., Vezeridis, M.P., Cohen, S.I., Wrobleski, D.E., Pelvic resection of recurrent rectal cancer (1994) Ann Surg, 220, pp. 586-595; Huguier, M., Houry, S., Barrier, A., Local recurrence of cancer of the rectum (2001) Am J Surg, 182, pp. 437-439; Delpero, J.R., Pol, B., Le Treut, Y.P., Surgical resection of locally recurrent colorectal adenocarcinoma (1998) Br J Surg, 85, pp. 372-376; Salo, J.C., Paty, P.B., Guillem, J., Minsky, B.D., Harrison, L.B., Cohen, A.M., Surgical salvage of recurrent rectal carcinoma after curative resection: A 10-year experience (1998) Ann Surg Oncol, 6, pp. 171-177; Law, W.L., Chu, K.W., Resection of local recurrence of rectal cancer: Results (2000) World J Surg, 24, pp. 486-490; Ogunbiyi, O.A., Mckenna, K., Birnbaum, E.H., Fleshman, J.W., Kodner, I.J., Aggressive surgical management of recurrent rectal cancer - Is it worthwhile? (1997) Dis Colon Rectum, 40, pp. 150-155; Hahnloser, D., Nelson, H., Gunderson, L.L., Curative potential of multimodality therapy for locally recurrent rectal cancer (2003) Ann Surg, 237, pp. 502-508; Yamada, K., Ishizawa, T., Niwa, K., Chuman, Y., Akiba, S., Aikou, T., Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer (2001) Br J Surg, 88, pp. 988-993; Lopez, M.J., Kraybill, W.G., Downey, R.S., Johnston, W.D., Bricker, E.M., Exenterative surgery for locally advanced rectosigmoid cancers. Is it worthwhile? (1987) Surgery, 102, pp. 644-651; Kendal, W.S., Cripps, C., Viertelhausen, S., Stern, H., Multimodality management of locally recurrent colorectal cancer (2002) Surg Clin North Am, 82, pp. 1059-1073.