Impact of a history of metastases or synchronous metastases on survival in patients with locally recurrent rectal cancer

E.L.K. Voogt*, D.M.G.I. van Zoggel, M. Kusters, G.A.P. Nieuwenhuijzen, J.S. Cnossen, G.J. Creemers, G. van Lijnschoten, J. Nederend, M.J. Roef, J.W.A. Burger, H.J.T. Rutten

*Corresponding author for this work

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Abstract

Aim Patients with locally recurrent rectal cancer (LRRC) frequently present with either synchronous metastases or a history of metastases. This study was conducted to evaluate whether LRRC patients without metastases have a different oncological outcome compared to patients with a history of metastases treated with curative intent or patients with potentially curable synchronous metastases.Method All consecutive LRRC patients who underwent intentionally curative surgery between 2005 and 2017 in a large tertiary hospital were retrospectively reviewed and categorized as having no metastases, a history of (curatively treated) metastases or synchronous metastases. Patients with unresectable distant metastases were excluded from the analysis.Results Of the 349 patients who were analysed, 261 (75%) had no metastases, 42 (12%) had a history of metastases and 46 (13%) had synchronous metastases. The 3-year metastasis-free survival was 52%, 33% and 13% in patients without metastases, with a history of metastases, and with synchronous metastases, respectively (P < 0.001) A history of metastases did not influence overall survival (OS), but there was a trend towards a worse OS in patients with synchronous metastases compared with patients without synchronous metastases (hazard ratio 1.43; 95% CI 0.98-2.11).Conclusion LRRC patients with a history of curatively treated metastases have an OS comparable to that in patients without metastases and should therefore be treated with curative intent. However, LRRC patients with synchronous metastases have a poor metastasis-free survival and worse OS; in these patients, an individualized treatment approach to observe the behaviour of the disease is recommended.
Original languageEnglish
Pages (from-to)1120-1131
Number of pages12
JournalColorectal Disease
Volume23
Issue number5
Early online date21 Jan 2021
DOIs
Publication statusPublished - May 2021

Keywords

  • distant metastases
  • locally recurrent rectal cancer
  • metastasis&#8208
  • free survival
  • overall survival
  • prognosis

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