Abstract
A retrospective analysis of the prognostic significance of anastomotic recurrence in 50 patients with colorectal adenocarcinoma was conducted from 1970 to 1987. All primary cancers were located above 10 cm from the anal verge. Forty anastomotic recurrences (80 percent) followed resection of sigmoid or proximal rectal tumors. The overall disease-free interval was 13 months, with 90 percent of recurrences diagnosed within 24 months of the primary resection. Forty-five recurrences (90 percent) were associated with synchronous or metachronous metastases. Overall median survival following the recurrence was 16 months–37 months if the anastomosis was the only recurrence site. Of five patients alive without evidence of disease, all were asymptomatic, and recurrence was confined to the anastomosis. In conclusion, anastomotic recurrence following resection of colorectal adenocarcinoma frequently heralds disseminated disease but can be potentially resected for cure if it is the only site in an otherwise asymptomatic patient.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Beal JM, Cornell GN. A study of the problem of recurrence of carcinoma of the anastomotic site following resection of the colon for carcinoma. Ann Surg 1956;143:1–7.
Southwick HW, Harridge TO, Cole WH. Recurrence at the suture line following resection for carcinoma of the colon: incidence following preventative measures. Am J Surg 1962;103:86–9.
Slanetz CA, Herter FP, Grinell RS. Anterior resection vs. abdominoperineal resection for cancer of the rectum and rectosigmoid. Am J Surg 1972;123:110–7.
Cass AW, Million RR, Pfaff WW. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–5.
Manson PN, Corman ML, Coller JA, Veidenheimer MC. Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience. Dis Colon Rectum 1976;19:219–24.
Welch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum. Am J Surg 1978;135:505–11.
Olson RM, Perencevich NP, Malcolm AW,et al. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer 1980;45:2969–74.
Pihl E, Hughes ES, McDermott FT,et al. Diseasefree survival and recurrence after resection of colorectal carcinoma. J Surg Oncol 1981;16:333–41.
Phil E, Hughes ES, McDermott FT,et al. Recurrence of carcinoma of the colon and rectum at the anastomotic suture line. Surg Gynecol Obstet 1981;153:495–6.
Malcolm AW, Perencevich NP, Olson RM,et al. Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum. Surg Gynecol Obstet 1981;152:131–6.
Herter FP, Colacchio TA. The influence of antibiotics on infection and anastomotic recurrence after colon resection for cancer. World J Surg 1982;6:188–94.
Sugarbaker PH, Carlew S. Influence of surgical techniques on survival in patients with colorectal cancer: a review. Dis Colon Rectum 1982;25:545–57.
Polk HC Jr, Spratt JS. Recurrent cancer of the colon. Surg Clin North Am 1983;63:151–60.
Buhler H, Seefeld U, Deyhle P,et al. Endoscopic follow-up after colorectal cancer surgery. Early detection of local recurrence? Cancer 1984;54:791–3.
Philpshen SJ, Heilweil M, Quan SH,et al. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.
Devereux DF, Deckers PJ. Contributions of pathologic margins and Dukes' stage to local recurrence in colorectal carcinoma. Am J Surg 1985;149:323–6.
Grabble E, Winkler R. Local recurrence after sphincter-saving resection for rectal and rectosigmoid carcinoma: value of various diagnostic methods. Radiology 1985;155:305–10.
McDermott FT, Hughes ES, Pihl E,et al. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 1985;72:34–7.
Barkin JS, Cohen ME, Flaxman M,et al. Value of routine follow-up endoscopy program for the detection of recurrent colorectal carcinoma. Am J Gastroenterol 1988;88:1355–60.
Stulc JP, Petrelli NJ, Herrera L,et al. Anastomotic recurrence of adenocarcinoma of the colon. Arch Surg 1986;121:1077–80.
Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg 1986;73:342–44.
Willett CG, Tepper JE, Cohen AM,et al. Failure patterns following curative resection of colonic carcinoma. Ann Surg 1984;200:685–90.
Heald RJ, Husband EM, Ryall RO. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982;69:613–6.
Cohn I Jr, Floyd CE, Atik M. Control of tumor implantation during operations on the colon. Ann Surg 1963;157:825–38.
Gubareff N, Sutzeff V. Preliminary report on the application of iodine in prevention of surgical dissemination of viable malignant cells. J Surg Res 1962;2:144.
Keynes WM. Implantation from the bowel lumen in cancer of the large intestine. Ann Surg 1961;13:357–64.
Keighley MR, Hall C. Anastomotic recurrence of colorectal cancer—a biological phenomenon or an avoidable calamity? Gut 1987;28:786–91.
Sunter JP, Higgs MJ, Cowan WK. Mucosal abnormalities at the anastomosis site in patients who have had intestinal resection for colonic cancer. J Clin Pathol 1985;38:385–9.
Author information
Authors and Affiliations
About this article
Cite this article
Rodriguez-Bigas, M.A., Stulc, J.P., Davidson, B. et al. Prognostic significance of anastomotic recurrence from colorectal adenocarcinoma. Dis Colon Rectum 35, 838–842 (1992). https://doi.org/10.1007/BF02047869
Issue Date:
DOI: https://doi.org/10.1007/BF02047869