Prognostic Impact of Recurrence Location in Locally Recurrent Rectal Cancer: A Single-Center Retrospective Study

Vollständiger Abstract

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Background/Aim: Locally recurrent rectal cancer (LRRC) remains challenging, and optimal treatment strategies vary by recurrence location. We retrospectively evaluated treatment patterns and outcomes of LRRC without distant metastasis, focusing on the Memorial Sloan Kettering Cancer Center (MSKCC) pelvic compartment classification. Patients and Methods: We retrospectively analyzed 20 patients with LRRC without distant metastasis treated at our institution between 2005 and 2025. Recurrence sites were categorized as axial, anterior, posterior, or lateral according to the MSKCC classification. Treatment modalities, resection margin status, perioperative outcomes, and survival were analyzed. Results: The median interval from primary tumor resection to LRRC diagnosis was 30 months. Ten patients had axial recurrence, two anterior, two posterior, and six lateral recurrence. Seventeen patients underwent surgery (surgery alone, n=8; preoperative therapy plus surgery, n=9), while three patients received nonsurgical management; all nonsurgical cases were lateral recurrence. Median blood loss, operative time, and postoperative length of stay among surgical cases were 592 ml, 477 min, and 29 days, respectively. Major postoperative morbidity (Clavien-Dindo ≥IIIb) occurred in one axial patient (bladder injury). R1 and R2 resections were observed in four (23.6%) and one (5.9%) surgical cases, respectively. Posterior (2/2) and lateral (3/6) recurrences more frequently required preoperative therapy and showed a high rate of re-recurrence. When grouped as axial/anterior versus posterior/lateral, overall survival and re-recurrence-free survival were significantly worse in the posterior/lateral group (p=0.044 and p=0.0059, respectively). Conclusion: MSKCC-based location stratification may be clinically useful for LRRC treatment. Posterior and lateral recurrences were associated with poor outcomes even after surgery, suggesting the need for careful patient selection and consideration of alternative or intensified multimodal strategies.