Skip to main content
SpringerLink
Log in

Rate of Pulmonary Metastasis Varies with Location of Rectal Cancer in the Patients Undergoing Curative Resection

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Precise understanding of recurrence patterns permits efficient surveillance and effective treatment strategies. The aim of this study was to evaluate recurrence patterns after treatment of rectal cancers, specifically with respect to tumor location and chemoradiotherapy (CRT).

Methods

A single-institution, retrospective cohort of 2,086 consecutive rectal cancer patients, was enrolled between January 2000 and December 2007. All the patients underwent curative operations (R0). Tumor location was classified into lower (≤5 cm), middle (>5 to ≤8 cm), and upper (>8 cm) groups based on the distance of the inferior tumor border from the anal verge; the patients were also characterized according to whether they received preoperative/postoperative CRT.

Results

The lung was the most common recurrence site in the lower group (lower vs. middle/upper; 14.6 vs. 8.9 %/8.0 %, P = 0.001/0.001). Recurrence patterns were not associated with receipt of preoperative/postoperative CRT. Additionally, RT and CRT did not reduce the rate of pulmonary recurrence (no-RT/preoperative CRT/postoperative CRT, 37.5/37.9/42.6 %; P = 0.13). In a multivariate analysis, preoperative level of serum carcinoembryonic antigen, abdominoperineal resection, advanced T category, N category, and circumferential resection margin were identified as independent risk factors for pulmonary recurrence in all groups. Otherwise, low rectal cancer was associated with unresectable pulmonary recurrence (RR = 2.19; 95 % CI 1.012–3.072; P = 0.04).

Conclusions

Neither RT nor CRT affects the pattern and rate of recurrence. Tumor location specifically affects recurrence in rectal cancer patients, such that the lower group is a risk factor for unresectable pulmonary recurrences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30

    Article  PubMed  Google Scholar 

  2. Brenner H, Bouvier AM, Foschi R et al (2012) Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study. Int J Cancer 131:1649–1658

    Article  CAS  PubMed  Google Scholar 

  3. Galandiuk S, Wieand H, Moertel C et al (1992) Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 174:27–32

    CAS  PubMed  Google Scholar 

  4. van Gestel YR, de Hingh IH, van Herk-Sukel MP et al (2014) Patterns of metachronous metastases after curative treatment of colorectal cancer. Cancer Epidemiol 38(4):448–454

    Article  PubMed  Google Scholar 

  5. Heald R, Ryall R (1986) Recurrence and survival after total mesorectal excision for rectal cancer. The Lancet 327:1479–1482

    Article  Google Scholar 

  6. Bosset J-F, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123

    Article  CAS  PubMed  Google Scholar 

  7. Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933

    Article  CAS  PubMed  Google Scholar 

  8. Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650

    Article  PubMed  Google Scholar 

  9. Moertel CG, Fleming TR, Macdonald JS et al (1993) An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 270:943–947

    Article  CAS  PubMed  Google Scholar 

  10. McCarthy K, Pearson K, Fulton R et al (2012) Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer. Cochrane Database Syst Rev 12:CD008368

    PubMed  Google Scholar 

  11. Watanabe K, Saito N, Sugito M et al (2011) Predictive factors for pulmonary metastases after curative resection of rectal cancer without preoperative chemoradiotherapy. Dis Colon Rectum 54:989–998

    Article  PubMed  Google Scholar 

  12. Tepper J, O’Connell M, Hollis D et al (2003) Analysis of surgical salvage after failure of primary therapy in rectal cancer: results from Intergroup Study 0114. J Clin Oncol 21:3623–3628

    Article  CAS  PubMed  Google Scholar 

  13. Kim HK, Cho JH, Lee HY et al (2014) Pulmonary metastasectomy for colorectal cancer: how many nodules, how many times? World J Gastroenterol 20:6133

    Article  PubMed Central  PubMed  Google Scholar 

  14. Kobayashi H, Mochizuki H, Sugihara K et al (2007) Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 141:67–75

    Article  PubMed  Google Scholar 

  15. Mitry E, Guiu B, Cosconea S et al (2010) Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut. doi:10.1136/gut.2010.211557

    PubMed Central  Google Scholar 

  16. Ding P, Liska D, Tang P et al (2012) Pulmonary recurrence predominates after combined modality therapy for rectal cancer: an original retrospective study. Ann Surg 256:111–116

    Article  PubMed  Google Scholar 

  17. Olson R, Perencevich N, Malcolm A et al (1980) Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer 45:2969–2974

    Article  CAS  PubMed  Google Scholar 

  18. Kim JC, Chang SY, Lim SB et al (2013) Abdominoperineal resection and low anterior resection: comparison of long-term oncologic outcome in matched patients with lower rectal cancer. Int J Colorectal Dis 28:493–501

    Article  PubMed  Google Scholar 

  19. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  CAS  PubMed  Google Scholar 

  20. Glynne-Jones R, Mawdsley S, Pearce T et al (2006) Alternative clinical end points in rectal cancer: are we getting closer? Ann Oncol 17:1239–1248

    Article  CAS  PubMed  Google Scholar 

  21. Assersohn L, Norman A, Cunningham D et al (1999) Influence of metastatic site as an additional predictor for response and outcome in advanced colorectal carcinoma. Br J Cancer 79:1800

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Yamada H, Ichikawa W, Uetake H et al (2001) Thymidylate synthase gene expression in primary colorectal cancer and metastatic sites. Clin Colorectal Cancer 1:169–173

    Article  CAS  PubMed  Google Scholar 

  23. Martijnse IS, Dudink RL, Kusters M et al (2012) T3+ and T4 rectal cancer patients seem to benefit from the addition of oxaliplatin to the neoadjuvant chemoradiation regimen. Ann Surg Oncol 19:392–401

    Article  PubMed  Google Scholar 

  24. Cercek A, Goodman KA, Hajj C et al (2014) Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer. J Natl Compr Cancer Netw 12:513–519

    Google Scholar 

  25. Graham RA, Wang S, Catalano PJ et al (1998) Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest X-ray, and colonoscopy. Ann Surg 228:59

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Kjeldsen B, Kronborg O, Fenger C et al (1997) A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg 84:666–669

    Article  CAS  PubMed  Google Scholar 

  27. Nordholm-Carstensen A, Krarup P-M, Jorgensen LN et al (2014) Occurrence and survival of synchronous pulmonary metastases in colorectal cancer: a nationwide cohort study. Eur J Cancer 50:447–456

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Authors specially appreciate Dr. Kim JH for his dedication to validate histologic findings and clinical staffs in the Colorectal Division (Drs. Lim SB, Kim CW, Park IJ, and Yoon YS) for the valuable provision of clinical database.

Disclosure

This study was supported by Grants (to J.C. Kim) from the Asan Institute for Life Sciences (2014-69), the Korea Research Foundation (NRF-2013R1A2A1A03070986), Ministry of Science, ICT, and Future Planning, the Korea Health 21 R&D Project (HI06C0868 and HI13C1750) and the Center for Development and Commercialization of Anti-Cancer Therapeutics (HI10C2014), Ministry of Health and Welfare, Republic of Korea.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Jong Lyul Lee, Chang Sik Yu & Jin Cheon Kim

  2. Department of Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Tae Won Kim

  3. Department of Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Jong Hoon Kim

Authors
  1. Jong Lyul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Sik Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae Won Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jong Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jin Cheon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Cheon Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.L., Yu, C.S., Kim, T.W. et al. Rate of Pulmonary Metastasis Varies with Location of Rectal Cancer in the Patients Undergoing Curative Resection. World J Surg 39, 759–768 (2015). https://doi.org/10.1007/s00268-014-2870-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2870-y

Keywords

Search

Navigation