[Locoregional recurrences of rectal cancers. Disappointments and hopes apropos of 54 cases].
From January 1985 to December 1993, 54 locoregional recurrences (LRR) of rectal cancer (RC) led to 30 surgical procedures, including 20 resections, of which 10 were palliative. There were 10 abdominoperineal resections (APR), 4 anastomotic resections, 4 Hartmann procedures, 2 tumoral excisions (eight of these operations were extended to other organs, locally or not). Median survival was 22.5 months after excision, 10.2 months after colostomy alone and 16.6 m in inoperable cases. Six patients are alive with recurrence and 7 without (median 31.5 months) of whom one 74 months after receiving extended APR with Bricker-type total cystectomy. Our review of the literature has shown how difficult and disappointing the treatment of LRR of RC is, and the need for early detection. Immunoscintigraphy with monoclonal antibodies (IS), which is only rarely mentioned in other published surgical studies, was used for 7 patients when diagnosis could not be made after usual explorations. IS confirmed the diagnosis of LRR in 5 cases and excluded it in the other two. IS (sensitivity: 90-100%, specificity: 79-97%), which is more accurate than CT scan or dynamic MRI, should be used at the slightest doubt during follow-up and contribute with echo-endoscopy to detect LRR early. Among the new techniques which could improve the prevention and treatment of LRR, we have used intraoperative radiotherapy (IOR) for the past year in 32 patients (including 15 invasive RC and 3 LRR of RC). In a study of LRR topography to find an eventual association with IOR, we found the following: on the one hand, no significant difference in distribution of the 54 LRR according to the anatomic quadrant of the pelvic-peritoneal cavity; on the other, an LRR site which differed 8 times from that of the primary tumour in the 31 cases in whom the latter was not circumferential.(ABSTRACT TRUNCATED AT 250 WORDS)