• Stefi Nordkamp, Eva L K Voogt, Desley M G I van Zoggel, Anna Martling, Torbjörn Holm, Gabriella Jansson Palmer, Chikako Suzuki, Joost Nederend, Miranda Kusters, BurgerJacobus W AJWADepartment of Surgical Oncology, Catherina Hospital, Eindhoven, the Netherlands., RuttenHarm J THJTDepartment of Surgical Oncology, Catherina Hospital, Eindhoven, the Netherlands.GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands., and Henrik Iversen.
• Department of Surgical Oncology, Catherina Hospital, Eindhoven, the Netherlands.
• Br J Surg. 2022 Jun 14; 109 (7): 623-631.

BackgroundThe optimal treatment for patients with locally recurrent rectal cancer (LRRC) is controversial. The aim of this study was to investigate different treatment strategies in two leading tertiary referral hospitals in Europe.MethodsAll patients who underwent curative surgery for LRRC between January 2003 and December 2017 in Catharina Hospital, Eindhoven, the Netherlands (CHE), or Karolinska University Hospital, Stockholm, Sweden (KAR), were studied retrospectively. Available MRIs were reviewed to obtain a uniform staging for optimal comparison of both cohorts. The main outcomes studied were overall survival (OS), local re-recurrence-free survival (LRFS), and metastasis-free survival (MFS).ResultsIn total, 377 patients were included, of whom 126 and 251 patients came from KAR and CHE respectively. At 5 years, the LRFS rate was 62.3 per cent in KAR versus 42.3 per cent in CHE (P = 0.017), whereas OS and MFS were similar. A clear surgical resection margin (R0) was the strongest prognostic factor for survival, with a hazard ratio of 2.23 (95 per cent c.i. 1.74 to 2.86; P < 0.001), 3.96 (2.87 to 5.47; P < 0.001), and 2.00 (1.48 to 2.69; P < 0.001) for OS, LRFS, and MFS respectively. KAR performed more extensive operations, resulting in more R0 resections than in CHE (76.2 versus 61.4 per cent; P = 0.004), whereas CHE relied more on neoadjuvant treatment and intraoperative radiotherapy, to reduce the morbidity of multivisceral resections (P < 0.001).ConclusionIn radiotherapy-naive patients, neoadjuvant full-course chemoradiation confers the best oncological outcome. However, neoadjuvant therapy does not diminish the need for extended radical surgery to increase R0 resection rates.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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