Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Table 1 Patterns and rates of recurrences after different approaches

Authors - year	Treatment	5-year local recurrence (%)			Metastases as a first site of recurrence (%)	Median time to LR
		Total	Isolated	Combined
Pilipshen et al[32] (1968-1976)	Pre-TME surgery	25.5	13.3	12.3	NA	16 mo
Heald et al[34] (1978-1986)	TME surgery	3.7	2.6	1.1	NA	14 mo
Swedish Trial[39] (1987-1990)	Pre-TME surgery/	23.0	13.0	10.0	11	NA
	sRT+ pre-TME	9.0	5.0	4.0	19
Mohiuddin et al[67] (1976-1989)	LRT+ Pre-TME	13.0	6.0	7.0	17	25 mo
German Trial[25] (1995-2002)	CRT+ TME/	6.0	3.0	3.0	20	NA
	TME + CRT	13.0	7.0	6.0	20
British Trial[44] (1998-2005)	sRT +TME/	4.7	2.0	2.7	19	NA
	TME+ selective CRT	11.5	6.1	5.4	21
Dutch Trial[41] (1996-1999)	TME surgery/	11.3	6.6	4.7	17 19.3	18 mo
	sRT+ TME	5.8	2.3	3.5		30 mo
Guillem et al[4] (1988-2002)	CRT+TME	4.3	2.3	2.0	22	23 mo
Yu et al[54] (1989-2001)	CRT+TME	8.3	6.3	2.0	NA	NA
Kim et al[56] (2001-2005)	CRT+TME	8.0	3.7	4.3	19	24 mo central 18 mo lateral
Kusters et al[58] (1993-2002)	Unilateral EL/	15.4 (only T3,T4 tumors)			NA	NA
	Bilateral EL	8.3 (only T3-T4 tumors)
Moriya et al[57] (1982-1991)	Nerve-sparing EL	6.2 (14 for N+ tumors)			12	17 mo

TME: Total mesorectal excision; sRT: Short-term preoperative radiotherapy; LRT: Preoperative long-term radiotherapy; CRT+TME: Pre-operative chemoradiotherapy; TME+CRT: Post-operative chemoradiotherapy; EL: Extended lymphadenectomy; NA: Not available; LR: Local recurrence.

Table 2 Relative incidence of sub-site locations of pelvic recurrences

Authors (yr)	Treatment	Axial or central (%)				Lateral (%)	Other (%)
		Anastomotic(perianastomotic)	Anterior(genitourinary)	Posterior(presacral)	Perineal
Gunderson et al[31]	Pre-TME surgery	-1	40	19	31	10
Pilipshen et al[32] (1968-1976)	Pre-TME surgery	40	10		402	10
Hruby et al[33] (1979-1996)	Pre-TME surgery	21	10.7	47	11	11
Dutch Trial[41] (1996-1999)	TME surgery	24	18	32	5	18	2.5
Dutch Trial[41] (1996-1999)	sRT+ TME	13	16	41	-	25	2.7
Syk et al[40] (1995-1999)	sRT +TME	373	30	10		18
Yu et al[54] (1989-2001)	CRT+ CRT	-	44	28	-	10	18.0
Hötch et al[12] (1998-2001)	RT+TME		604	29		10
Kim et al[56] (2001-2005)	CRT+TME		205			80
Kusters et al[58] (1993-2002)	Unilateral EL	25	-	16	16	406
Kusters et al[58] (1993-2002)	Bilateral EL	20	10	16	16	40

APR: Abdominoperineal resection; Anast: Anastomotic; perin: Perineal; Ant: Anterior.

¹0% were APR;

²Post + perineum;

³Anast + ant;

⁴Perin + ant + anast;

⁵Axial o central;

⁶20% ipsilateral and 20% contralateral. TME: Total mesorectal excision; sRT: Short-term preoperative radiotherapy; EL: Extended lymphadenectomy; CRT: Chemoradiotherapy.