Multidisciplinary Treatment for Local Recurrence of Rectal Cancer
Purpose: The aim of this study was to confirm retrospectively that multidisciplinary treatment including cryosurgery and chemotherapy (Mitomycin C, 5-FU, UFT) for recurrence of rectal cancer had a palliative benefit. Methods: From among 556 cases of rectal cancers (Dukes A : 154, B : 142, C : 165, D : 95) treated during the past 21 years, we studied 57 cases with local recurrence (multidisciplinary: 15 cases, reoperation: 29 cases, conservative: 13 cases). Two cases of the 57 were referred to us from other institutions. Eight of the 15 multidisciplinary group cases had been previously reoperated upon for local recurrence. Results : The one-, three-, and five-year survival rates after treatment for local recurrence of rectal cancer were respectively as follows; multidisciplinary: 38.7%, 0%, 0%, reoperation: 51.7%, 11.4%, 0%, conservative: 30.8%, 0%, 0%. There were no significant differences between any combinations of the three treatments. However, significant differences were found in the three-, and five-year survival rates from first surgery, which were respectively as follows; multidisciplinary: 63.8%, 23.9%, reoperation : 67.3%, 50.5%, conservative: 30.8%, 0%. There were significant differences (p<0.01) between reoperation and conservative as well as between multidisciplinary and conservative treatments. The first choice of treatment for local recurrence was reoperation if possible. The only difference in indication between multidisciplinary and conservative treatments was whether or not the recurring tumor was treatable by cryosurgery. Conclusion : Whenever cases with a recurring tumor from rectal cancer complain of anal pain or inveterate bleeding, an attempt should be made to control such symptoms using multidisciplinary treatment.