Long-term outcomes following surgery for retroperitoneal recurrence of colorectal cancer

The authors evaluated the long-term outcomes of patients undergoing surgical resection for retroperitoneal recurrence of colorectal cancer.

Patients who undergo curative resection (surgical removal of the cancer) for primary colorectal cancer have a 30–50% chance of disease recurrence (return of the disease). While the majority of patients develop distant metastasis (spread of the cancer) to the liver or lungs, 4–10% of patients may experience retroperitoneal recurrence.  Retroperitoneal recurrence is return of the cancer behind the thin layer of tissue that lines the cavity of the abdomen and the abdominal organs.

There are very few studies that assess the effectiveness of resection for retroperitoneal recurrence. This study reports the long-term outcomes of resection for retroperitoneal recurrence in colorectal cancer.

The records of 48 patients were analyzed for this study. In 40 patients the retroperitoneal recurrence was deemed to be an isolated site of recurrence. 18 patients received preoperative radiation therapy while 20 patients received preoperative chemotherapy. 33 patients had an R0 resection (surgery for cure or complete remission; absolute absence of cancer cells), 5 patients had an R1 resection (the margins of the resected tumor showed presence of cancer cells under the microscope) and 2 had an R2 resection (portions of the tumor that were visible to the naked eye were not removed). Average follow-up was 32 months.

The 5-year overall survival rate (the percentage of people alive 5 years after treatment) for the entire group of patients was 70%. The average overall survival length was 80 months. In the 6 patients who had residual disease after resection, overall survival was significantly reduced. Older age was associated with a 7.5% decrease in the risk of death, with each additional year being associated with an approximate 8% reduction in mortality (death). Those with residual disease following resection were 4 times more likely to have reduced overall survival. There was a trend towards better overall survival in those with an R0 status following resection.

At the last follow-up, 43 patients were determined to be disease-free. 21 of these patients experienced re-recurrence after resection. The rate of 5-year disease-free survival (the percentage of people without disease after 5 years) was 49% for this group, with the average time to recurrence being 38 months. Older age was associated with a 6.2% decrease in the risk of recurrence. Those with an R1 status (presence of cancer cells in the margins of the resected tumor) were over 3.5 times more likely to re-recur than those with a R0 status.

The authors determined that resection of retroperitoneal recurrence can increase the overall survival rate and the average survival time in colorectal cancer patients.