Surgery of local recurrence in rectal cancer.

The local recurrence, after radical exeresis of a large intestinal cancer represents until now an extremely interesting question, taking into consideration that it represents the cause of death in 50% of operated patients. Frequency is higher after an exeresis of a rectal cancer, with a range of 2.6-83% in the different case histories, than after a surgical intervention on a colon cancer, whose incidence is lower than 5%. The early diagnosis of rectum cancer recurrence is the first step towards the favourable issue of treatment. Surgical treatment of loco-regional recurrences of rectum cancer can be curative when it is possible to perform a total resection of the recurrences and of the infiltrated structures, without microscopic residuals of disease, or palliative, aiming to reset the intestinal and urinary functions or to reduce pain. At the Department of Surgery of the University of Perugia, from January 1984 to December 1983, 153 patients with rectal cancer-79 males (52%) and 74 females (48%)-were treated. The operations, all involved total removal of the affected segment and were in 88 cases (58%) an anterior resection and in 65 cases (42%) an abdomino-perineal amputation. The analysis was made of 128 patients with a follow-up of at least five years; the local recurrence incidence was 12.5%. The authors adopted a follow-up protocol based on clinical examination, CEA antigen and routine Lab tests, chest X-rays, colonoscopy, abdominal ultrasonography, pelvic CT scan; these procedures are performed starting 3 months after operation.