Letter to the Editor
Anastomotic recurrence 13 years after curative resection for rectal cancer
Recidiva en la anastomosis 13 años después de cirugía curativa para cáncer de recto
Martín Bailón-Cuadrado
, José I. Blanco-Álvarez, Mario Rodríguez-López
Corresponding author
Servicio de Cirugía General y Digestiva, Hospital Universitario Río Hortega, Valladolid, Spain
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Blanco-Álvarez, Mario Rodríguez-López" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Martín" "apellidos" => "Bailón-Cuadrado" "email" => array:1 [ 0 => "martin.bc1988@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "José I." "apellidos" => "Blanco-Álvarez" ] 2 => array:2 [ "nombre" => "Mario" "apellidos" => "Rodríguez-López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía General y Digestiva, Hospital Universitario Río Hortega, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recidiva en la anastomosis 13 años después de cirugía curativa para cáncer de recto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Local recurrence following curative surgery of rectal cancer is still a very important problem, although its frequency has decreased by up to 8% with the generalization of total mesorectal excision and with both adjuvant and neoadjuvant oncological treatments.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In fact, multiple studies show that local recurrence is lower and occurs later, and that disease-free survival is higher when neoadjuvant treatment is used with chemotherapy and radiotherapy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> There are many factors that cannot be easily modified which influence cancer prognosis, such as the AJCC TNM staging, perineural and lymphovascular infiltration, peritumoral fibrosis, histological type and degree of differentiation, and the degree of tumor regression after the neoadjuvant therapy. On the other hand, there are other prognostic factors that are more easily controllable because they are within our reach from a surgical point of view, such as the absence of infiltration of the surgical margins and the preservation of the radial margin.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Nearly half of the patients who experience recurrence after surgery for rectal cancer have a disease confined to the pelvis. The ideal treatment is surgical resection, which achieves very acceptable results in the long term. However, when surgery is not a curative option, survival hardly exceeds 6–7 months despite cancer palliative treatment.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 59-year-old man, with no history of interest, was admitted to our hospital for lower gastrointestinal bleeding over several weeks. A colonoscopy was performed, which showed a rectal neoplasm located at 7<span class="elsevierStyleHsp" style=""></span>cm of the external anal margin. The anatomopathological study of the endoscopic biopsy confirmed the adenocarcinoma. Imaging tests carried out to complete the extension study did not show lymphadenopathy or distant metastases. The patient did not receive neoadjuvant cancer treatment because of the clinical presentation of the tumor, rather, he underwent surgery. An open low anterior resection was performed with a mechanical end-to-end colorectal anastomosis and a protective ileostomy. The anatomopathological study of the surgical specimen revealed that the lesion corresponded to a stage IIA (T3 N0) as per AJCC and had a moderate degree of differentiation (G2). The patient underwent adjuvant cancer therapy with chemotherapy and radiotherapy. Derivative stoma was then closed. During the 10-year follow-up, all controls performed with both endoscopy and CT were absolutely normal. Thirteen years after surgery, a colonoscopy was performed due to rectal bleeding, where a neoplastic stenosis was observed on the colorectal anastomosis. The anatomopathological study of the biopsy taken endoscopically confirmed that it was an adenocarcinoma. Even at that time, the levels of the tumor markers (CEA and CA 19.9) remained strictly normal. In the imaging tests performed to complete the extension study, a pleural effusion was observed, and a cytological study after thoracentesis established a metastatic origin. These findings evidenced an incurable recurrence and the patient was referred to the palliative care unit of our center.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although local recurrence after curative resection for rectal cancer has decreased in recent times, it still represents a significant problem, as it implies disease unresectability in half of the patients who develop it. There are several factors that determine the prognosis of rectal cancer; among the most important are the absence of surgical resection margin involvement and total mesorectal excision by preserving the mesorectal fascia. When a local recurrence occurs, 70% do it in the first 2 years, 85% in the first 3, 89% in the first 5, 98% in the first 7, and practically 100% do it within the first 10 years after surgery.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> According to these data and the findings we describe in this patient, the fact that a recurrence took place 13 years after curative resection for rectal cancer is a highly unusual finding, so much so that we have not found any other similar case in the literature.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bailón-Cuadrado M, Blanco-Álvarez JI, Rodríguez-López M. Recidiva en la anastomosis 13 años después de cirugía curativa para cáncer de recto. Med Clin (Barc). 2017;149:43–44.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The content of this manuscript has been accepted as part of the XVIII Conference of ACIRCAL (Association of Surgeons of Castile and Leon), held on 2nd and 3rd June 2016 in Salamanca, Spain.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery for locally recurrent rectal cancer: tips, tricks, and pitfalls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.K. Warrier" 1 => "A.G. Heriot" 2 => "A.C. 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Solomon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10350-007-9152-9" "Revista" => array:6 [ "tituloSerie" => "Dis Colon Rectum" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "284" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18204879" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014900000001/v1_201707230028/S2387020617303911/v1_201707230028/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014900000001/v1_201707230028/S2387020617303911/v1_201707230028/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303911?idApp=UINPBA00004N" ]
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