Advances in surgical management for locally recurrent rectal cancer: How far have we come?

Table 1 Conditions previously deemed contraindication to surgery for recurrent rectal cancer

Distant metastases
Stage IV primary disease
Sacral invasion above S2-S3
Diffuse/circumferential pelvic sidewall involvement resulting in hydronephrosis
Encasement (> 180°)of external iliac vessels
Invasion to anterior pubic bone
Extension of tumour through the sciatic notch

Table 2 Results of previous studies of composite abdominal-sacral resection for recurrent rectal cancer

Studies	n	Morbidity	Mortality	R0	Survival
Sagar et al[42]	40	60%	2.5%	50%	56% (3-yr)
Ferenschild et al[43]	17	68%	0%	NA	46% (3-yr)
					30% (5-yr)
Melton et al[44]	29	58%	3.4%	62%	63% (2-yr)
					20% (5-yr)
Moriya et al[45]	57	58%	4%	84%	54% (3-yr)
Weber et al[46]	23	78%	0%	91%	51% (3-yr)

Table 3 Studies on laparoscopic surgery for recurrent rectal cancer

Ref.	Year	Study design	No. of patients	Site of recurrence	Median blood loss, mL (range)	Median operative time, min (range)	R0 resection rate	Overall postoperative mortality/morbidity rate
Lu et al[70]	2006	Case series	7	Central recurrence: 6	200 (109-291)	211 (198–224)	100%	NR
				Presacral: 1
Kim et al[71]	2008	Case report	1	Central/anastomotic recurrence	50	185	100%	NR
Park et al[72]	2011	Comparative study	Lap: 15	Anastomotic site, ovary and pelvic lateral LN	NR	Lap: 150 (48-460)	Lap: 100%	Lap: 13.3%
			Open: 26			Open: 259 (40-514)	Open: 84.6%	Open: 57.7%
						P = 0.059	P = NS	P ≤ 0.05
Nagasaki et al[73]	2014	Comparative study	Lap: 13	Central and Lateral pelvic LN	Lap: 110 (60-800)	Lap: 381 (227-554)	Lap: 100%	Lap: 30.8%
			Open: 17		Open: 450 (25-1600)	Open: 241 (125-694)	Open: 94%	Open: 23.5%
					P = 0.075	P = 0.024	P = 0.99	P = 0.69
Akiyoshi et al[74]	2015	Case series	9	Lateral pelvic LN	130 (25-200)	381 (227-554)	100%	33.30%