World Journal of Surgery

, Volume 39, Issue 3, pp 759–768 | Cite as

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

  • Jong Lyul Lee
  • Chang Sik Yu
  • Tae Won Kim
  • Jong Hoon Kim
  • Jin Cheon KimEmail author
Original Scientific Report



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).


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.


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).


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.


Rectal Cancer Circumferential Resection Margin Lower Rectal Cancer Recurrence Pattern Systemic Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


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.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Jong Lyul Lee
    • 1
  • Chang Sik Yu
    • 1
  • Tae Won Kim
    • 2
  • Jong Hoon Kim
    • 3
  • Jin Cheon Kim
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulRepublic of Korea
  2. 2.Department of OncologyUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulRepublic of Korea
  3. 3.Department of Radiation OncologyUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulRepublic of Korea

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