Benefits of radioimmunoguided surgery for pelvic recurrence

Aim: Surgery for recurrent rectal cancer is usually traumatic and of questionable curative value. The use of radioimmunoguided surgery (RIGS®) in enhancing the surgeon's assessment of the extent of disease in these patients was investigated. Methods: Twenty-one patients diagnosed with recurrent pelvic cancer were operated using the RIGS® system. Preoperative assessment included CTs of chest, abdomen and pelvis as well as colonoscopy. Patients were injected with CC49, a monoclonal antibody (MoAb) labelled with ¹²⁵I. Surgical exploration was followed by survey with the gamma-detecting probe. Results: Surgical exploration identified eight intra-colorectal recurrences, nine extra-colonic pelvic recurrences and five extra-pelvic lymph node metastases. RIGS exploration confirmed all intra-colonic recurrences except for one (patient with no MoAb localization), identified 13 pelvic recurrences and 10 lymph node metastases. There were seven patients with occult findings (33%), resulting in a modified surgical procedure. Surgery included five abdominoperineal resections, six low anterior resections, seven excisions of presacral tumour, eight total abdominal hysterectomy and bilateral salpingo-oophorectomy, one pelvic exenteration and one post-exenteration. There were no operative deaths. Eight patients had minor complications, and one patient had a major complication with reoperation due to urinary leak. The mean follow-up was 18 months. Ten patients died of disease. Conclusion: Although not curative, RIGS can help the surgeon in the decision-making process through better disease staging.