Potential for surgical salvage of recurrent XXXX is governed by patterns of recurrence and ability to achieve an R0 resection.

@entity1 @entity146 @entity5 @entity1753 @entity3
UNASSIGNED: 3759 Background: Recurrence after initial resection of @entity5 often presents with local regional disease and distant @entity3 . @entity146 monitoring and surgical intervention is controversial. A recent intergroup adjuvant therapy study (0114) reported single site recurrence (potentially resectable) in 73% of 715 @entity1 , of whom 34% had re-resection with 27% survival (Tepper, JCO 2003;21:3623). We reviewed our multidisciplinary program of aggressive monitoring and resection of @entity5 recurrence to determine @entity1 selection parameters augering for optimal resection and survival. METHODS: 123 @entity1 were referred with recurrent @entity5 . Median age 61, M/F 58%/42%, Primary Stage I/II 48%, III/IV 49%. Primary surgery included anterior resection (AR) - 67 pts (59%), abdominal perineal resection (APR)-44 pts (36%), and exenteration - 3pts, plus resection other organ -6pts and liver resection - 3pts. Adjuvant chemo/radiation was given to 76 pts (62%). Median recurrence time: 22 mo. The pattern of recurrence was: local -65 pts (53%), distant mets - 40 pts. (33%), local and distant 18 pts. (15%), Recurrence site: singular in 96 pts (78%) and multiple in 27 (22%). LOCATION: anastamotic or bowel wall - 13 pts. (11%), pelvic 52 pts. (42%), extra pelvic (regional nodes) - 10 (8%) and distant = liver - 33 pts (27%), lung 25 pts. (20%), brain 3 pts (2.9%) bone 2 pts. (16%). Curative resections: 59 pts. (79%) with pelvic/extrapelvic recurrence and 15 (37%) of pts with distant @entity3 . @entity1753 was given in 67% of @entity1 . RESULTS: See table. CONCLUSIONS: The optimum pattern of single site of recurrence or @entity3 with long free interval permitted curative R0 resection in 60% (74pts) with long-term survival in 28% of @entity1 . Survival was similar following resection of local/pelvic recurrence or distant @entity3 . [Figure: see text] No significant financial relationships to disclose.
