Predictors of Successful Salvage Surgery for Local Pelvic Recurrence of Rectosigmoid Colon and Rectal Cancers

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Abstract
We investigated the predictors of successful resection of recurrent tumors and improved survival in patients with local pelvic recurrence of rectosigmoid colon and rectal cancer. We analyzed the clinicopathological factors of 94 patients who underwent treatment between 1993 and 2002 for the local pelvic recurrence of curatively resected primary rectosigmoid colon and rectal adenocarcinoma. Of the 94 patients, 48 underwent salvage surgery and 46 were treated conservatively. The survival rate of the patients who underwent salvage surgery was significantly higher than that of those treated conservatively (P < 0.0001). Logistic regression analysis revealed that the following factors were significantly associated with successful salvage surgery: tumor differentiation (well or moderately; P < 0.04), a long interval between the initial operation and the detection of recurrence (P < 0.03), and negative lymph node status at the initial operation (P < 0.02). The Cox proportional hazard model revealed the following predictors of better survival after surgery: tumor differentiation (well and moderate), negative lymph node status at the initial operation (pN0), and a perianastomotic pattern of recurrence. The predictors of successful salvage surgery are the tumor differentiation and nodal status of the primary tumor, the interval between the initial operation and the detection of recurrence, and the pattern of tumor recurrence.