Surgery for locally recurrent @entity5 in the era of XXXX : is there still a chance for cure?

@entity1 @entity348 @entity5
OBJECTIVE: To evaluate the perioperative outcome and long-term survival of @entity1 who underwent surgical resection for recurrent @entity5 within a multimodal approach in the era of @entity348 ( @entity348 ). BACKGROUND: Introduction of @entity348 has reduced local recurrence and improved oncological outcome of @entity1 with @entity5 . Local recurrence after @entity348 still occurs in 2% to 8% of @entity1 and presents a challenge to surgical and medical oncologists. However, there has been very limited data on the perioperative and long-term outcome of @entity1 who are operated for local recurrence in the era of @entity348 . METHODS: A total of 107 @entity1 who were identified from a prospective @entity5 database underwent surgical exploration for recurrent @entity5 after previous @entity348 between October 2001 and April 2009. Risk factors of perioperative morbidity were analyzed using a multivariate logistic regression model. Independent predictors of disease-specific survival were identified by a Cox proportional hazards regression model, as were those of local recurrence and disease recurrence at any site. RESULTS: Surgical resection was performed in 92 @entity1 and negative resection margins were achieved in 54 (58.7%) of these. Recurrent disease was located intraluminally and extraluminally in 35 (38.0%) @entity1 and 57 (62.0%) @entity1 , respectively. A total of 19 (20.6%) @entity1 had metastatic extrapelvic disease at the time of surgery. Perioperative surgical morbidity and in-hospital mortality accounted for 42.4% and 3.3%, respectively. On multivariate analysis, partial sacrectomy was associated with surgical morbidity (P = 0.004). Three- and 5-year disease-specific survival rates were 61% and 47%. Three-year survival rate of @entity1 with extrapelvic disease who underwent R0 resection was 42%. On multivariate analysis, surgical morbidity (P = 0.001), presence of extrapelvic disease (P = 0.006), and noncurative (R1; R2) resection (P < 0.0001) were identified as independent adverse predictors of disease-specific survival, whereas a transabdominal resection (as opposed to an abdominoperineal resection/pelvic exenteration) was associated with a more favorable prognosis (P = 0.04). CONCLUSIONS: Surgical resection of local recurrence from @entity5 in the era @entity348 can be carried out with acceptable morbidity and curative resection rates. Curative resection remains the major prognostic factor and may enable long-term survival even in @entity1 with extrapelvic disease.
