Operative versus non-operative treatment for recurrent rectal cancer: impact on long-term survival

The present paper compares long-term survival rates of surgery versus non-operative treatments in patients with recurrent rectal cancer (RRC).

Rectal cancer is cancer in the final section of the large intestine, or rectum. Surgery to remove the cancer is the first choice of treatment, but chemotherapy with or without radiation is given in more advanced stages. RRC is a cancer that has returned (recurred) after it has been treated. RRC may reoccur in the rectum (local recurrence) or in other parts of the body (distant recurrence). Treatment for RRC includes surgery to remove local recurrences or chemotherapy with or without radiation if the surgeon cannot remove the cancer completely. This study compared the survival rates of patients undergoing surgery versus non-operative treatments for RRC.

The study included 127 RRC patients, 84% with local recurrence and 16% who had distant recurrence. After the primary surgery (performed for the first occurrence), recurrence rates (the percentage of patients who had recurrence after a defined period of time) were 22% at 1 year; 72% at 3 years and 96% at 5 years.

For the RRC (secondary cancer), 70 patients (55%) had surgery whereas 57 patients (45%) were not operated (received radiation and/or chemotherapy). Patients who underwent secondary surgery had a 3-years overall survival (the percentage of patients who have survived for a defined period of time) of 20% to 69%, depending on the extent of surgical resection (incomplete cancer resection or complete removal of the cancer, respectively). There was no benefit from incomplete cancer resection compared to non-operated patients, with a median survival rate of 25 and 30 months respectively.

In summary, most RRC occur within 5 years after surgery for the primary rectal cancer and complete removal of the recurrent cancer is the treatment of choice, which leads to long-term survival. However, this study showed no benefit in incomplete resection of the recurrence compared to non-operated patients with RRC.

The study included a small number of patients with various stages of cancer, making it harder to draw conclusions applying for each sub-group. Most patients who had complete resection of the cancer had more confined disease, thus having a better prognosis than patients who presented with distant recurrences, irrespective of the treatment.