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Revista chilena de cirugía

versión On-line ISSN 0718-4026

Resumen

BANNURA C, Guillermo. Treatment of local relapses of rectal cancer. Rev Chil Cir [online]. 2014, vol.66, n.5, pp.494-501. ISSN 0718-4026.  http://dx.doi.org/10.4067/S0718-40262014000500017.

The treatment of local relapses of rectal cancer requires a multimodal strategy. The preoperative assessment should consider the performance status of the patient, determine the precise anatomical involvement and look for distant metastases. The risk factors for a local relapse are the height of the tumor, the type of intervention, an elevated carcinoembryonic antigen in the preoperative period, the circumferential margin involvement and the stage of the tumor. The prognostic factors for an established local relapse are the type of surgery for the primary tumor (local excision, anterior or abdominoperineal resection), the type of relapse (staging), the presence of symptoms (profound pelvic pain) and specially the possibility of achieving a complete resection. A systematic analysis of 55 reports concluded that a radical resection with curative intention was achieved in 40% of cases. Preoperative external or intraoperative radiotherapy was used in 12 to 97% and 8 to 91% of cases respectively. Thirty days postoperative mortality was 2.2%, the rates of local control of the tumor ranged from 29 to 100% and five years survival was at least 25% with a superior limit of 41%. Although there are no clear guidelines for the management of these patients, there is a growing consensus in the use of preoperative radiotherapy to achieve better surgical results. Therefore a multimodal treatment of local relapses is justified.

Palabras clave : Rectal cancer; local relapse; surgery.

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