Analysis of the causes of local recurrence after rectal cancer surgery

Radical resection of rectal cancer is an ideal surgery to avoid local recurrence after surgery because it removes enough primary cancer and clears a sufficient range of surrounding lymph nodes. If the surgery is not performed according to this principle, it is easy to cause local recurrence after surgery. According to many literature reports, the local recurrence rate is 5% to 20%. The recurrence rate of tumors in different parts is different. Among them, local recurrence of rectal cancer and sigmoid colon cancer is the most common, and cecal cancer is the most common colon cancer in other parts. The location of the tumor can be arranged in the following order: rectum, sigmoid colon, right colon, left colon, transverse colon. The lower the location of rectal cancer, the higher the local recurrence rate. The possible reason is that the lower the location of the tumor, the closer the structure with the surrounding organs, the easier it is to spread locally, and the more likely the radicality of the surgery is to be limited.

1. Age Factor

Since most patients with colorectal cancer are older, have dull senses, slow gastrointestinal motility, and some have had hemorrhoids or habitual constipation for many years, their clinical symptoms are atypical and their Dukes stage is often late when they seek medical treatment, which increases the chance of recurrence after surgery.

2. Anatomical factors

Colon cancer can be removed over a wider area and can generally be cured, so the recurrence rate is lower than that of rectal cancer. However, rectal cancer is located lower, deep in the pelvic cavity, has a smaller area, is close to the anal sphincter, and is adjacent to the bladder or vagina. Therefore, it is not easy to completely cure it, and the local recurrence rate is high.

3. Tumor staging

Dukes. staging is one of the important factors for postoperative recurrence of colorectal cancer. Normal large intestine has rich vascular networks and lymphatic vessels in the submucosal layer, so tumors originating from the mucosal epithelium penetrate the muscular layer to the submucosal layer, which means that lymph node metastasis may occur. The more severe the tumor spreads outside the intestinal wall, the greater the possibility of cancer spreading to the abdominal cavity, pelvic cavity and infiltration.