Skip to main content

Anastomotic Recurrence After Curative Resection for Colorectal Cancer

World Journal of Surgery volume 41, pages 285–294 (2017)Cite this article

Abstract

Background

A precise understanding of anastomotic recurrence (AR) permits efficient surveillance and treatment strategies. This study aimed to evaluate the clinicopathologic characteristics of patients with AR undergoing curative resection for colorectal cancer (CRC), compare colonic with rectal tumors and investigate the risk factors related to AR.

Methods

A single-institution, retrospective cohort of 9024 patients who underwent curative surgery for CRC between 2000 and 2010 was enrolled. Patients were classified into AR group (n = 53) or non-AR group (n = 8971) and were also characterized by tumor location.

Results

The AR group was independently associated with old age (p = 0.046), advanced N stage (p = 0.003), the rectum (p = 0.001), a large tumor (p = 0.001) and mucinous differentiation (MU) (p = 0.026). In colon cancers, the AR group (n = 20) was independently associated with MU (p = 0.022) and lymphovascular invasion (LVI) (p = 0.001). In rectal cancers, the AR group (n = 33) was independently associated with N2 stage (p = 0.007) and a large tumor (p < 0.001). AR is a burden to patients and physicians because these tumors have a poor prognosis and more advanced pathologic stages than the primary tumors. However, N0 stage and curative resection of an AR tumor (p = 0.001 and p < 0.001, respectively) were found to be independently associated with improved survival in a Cox regression model.

Conclusion

AR is independently associated with the rectum. In colon cancers, MU and LVI are independent risk factors for AR. In rectal cancers, a large tumor and N2 stage are independent risk factors for AR. Although AR shows a poor prognosis, early detection and curative resection may lead to an improved survival.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Wright HK, Thomas WH, Cleveland JC (1969) The low recurrence rate of colonic carcinoma in ileocolic anastomoses. Surg Gynecol Obstet 129:960–962

    CAS  PubMed  Google Scholar 

  2. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture. Br J Surg 71:12–16

    CAS  Article  PubMed  Google Scholar 

  3. Jones PF (1987) Anastomotic recurrence of colorectal cancer. Gut 28:1691–1692

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Matsuda A, Kishi T, Musso G et al (2013) The effect of intraoperative rectal washout on local recurrence after rectal cancer surgery: a meta-analysis. Ann Surg Oncol 20:856–863

    Article  PubMed  Google Scholar 

  5. Lopez-Kostner F, Fazio VW, Vignali A, Rybicki LA, Lavery IC (2001) Locally recurrent rectal cancer: predictors and success of salvage surgery. Dis Colon Rectum 44:173–178

    CAS  Article  PubMed  Google Scholar 

  6. Sagar PM, Pemberton JH (1996) Surgical management of locally recurrent rectal cancer. Br J Surg 83:293–304

    CAS  Article  PubMed  Google Scholar 

  7. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

    CAS  Article  PubMed  Google Scholar 

  8. Hubens G, Lafullarde T, Van Marck E, Vermeulen P, Hubens A (1993) Implantation of colon cancer cells on intact and damaged colon mucosa and serosa: an experimental study in the rat. Acta Chir Belg 94:258–262

    Google Scholar 

  9. McGregor JR, Galloway DJ, McCulloch P, George WD (1989) Anastomotic suture materials and implantation metastasis: an experimental study. Br J Surg 76:331–334

    CAS  Article  PubMed  Google Scholar 

  10. Umpleby HC, Fermor B, Symes MO, Williamson RC (1984) Viability of exfoliated colorectal carcinoma cells. Br J Surg 71:659–663

    CAS  Article  PubMed  Google Scholar 

  11. Williamson RCN (1982) Postoperative adaptation in the aetiology of intestinal cancer. In: Robinson JWL, Dowling RH, Riecken E-O (eds) Mechanisms of intestinal adaptation. MTP press, Lancaster, pp 621–636

    Google Scholar 

  12. Williamson RC, Davies PW, Bristol JB, Wells M (1982) Intestinal adaptation and experimental carcinogenesis after partial colectomy. Increased tumour yields are confined to the anastomosis. Gut 23:316–325

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. Hohenberger W, Wever K (2009) Standardized surgery for colonic cancer; complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis 11:354–364

    CAS  Article  PubMed  Google Scholar 

  14. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  15. Kim YW, Kim NK, Min BS et al (2009) Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol 99:58–64

    Article  PubMed  Google Scholar 

  16. Chao YK, Yeh CJ, Chang HK et al (2011) Impact of circumferential resection margin distance on locoregional recurrence and survival after chemoradiotherapy in esophageal squamous cell carcinoma. Ann Surg Oncol 18:529–534

    Article  PubMed  Google Scholar 

  17. Liebig C, Ayala G, Wilks JA, Berger DH, Albo D (2009) Perineural invasion in cancer. Cancer 115:3379–3391

    CAS  Article  PubMed  Google Scholar 

  18. Sato T, Ueno H, Mochizuki H et al (2010) Objective criteria for the grading of venous invasion in colorectal cancer. Am J Surg Pathol 34:454–462

    Article  PubMed  Google Scholar 

  19. Washington MK, Berlin J, Branton P et al (2009) Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 133:1539–1551

    PubMed  PubMed Central  Google Scholar 

  20. Pihl E, Hughes ES, McDermott FT, Milne BJ, Price AB (1981) Disease-free survival and recurrence after resection of colorectal carcinoma. J Surg Oncol 16:333–341

    CAS  Article  PubMed  Google Scholar 

  21. Cass AW, Million RR, Pfaff WW (1976) Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 37:2861–2865

    CAS  Article  PubMed  Google Scholar 

  22. Umpleby HC, Williamson RC (1987) Anastomotic recurrence in large bowel cancer. Br J Surg 74:873–878

    CAS  Article  PubMed  Google Scholar 

  23. Goligher JC, Dukes CE, Bussey HJ (1951) Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg 39:199–211

    CAS  Article  PubMed  Google Scholar 

  24. Hurst PA, Prout WG, Kelly JM, Bannister JJ, Walker RT (1982) Local recurrence after low anterior resection using the staple gun. Br J Surg 69:275–276

    CAS  Article  PubMed  Google Scholar 

  25. Hardy KJ, Cuthbertson AM, Hughes ESR (1968) Suture-line neoplastic recurrence following large-bowel resection. Aust N Z J Surg 38:44–46

    Article  Google Scholar 

  26. Zhou C, Ren Y, Wang K, Liu J, He JJ, Liu PJ (2013) Intra-operative rectal washout with saline solution can effectively prevent anastomotic recurrence: a meta-analysis. Asian Pac J Cancer Prev 14:7155–7159

    Article  PubMed  Google Scholar 

  27. Hasegawa J, Nishimura J, Yamamoto S et al (2011) Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning. Int J Colorectal Dis 26:875–880

    Article  PubMed  PubMed Central  Google Scholar 

  28. Park JS, Huh JW, Park YA et al (2015) Prognostic comparison between mucinous and nonmucinous adenocarcinoma in colorectal cancer. Medicine (Baltimore) 94:e658

    CAS  Article  Google Scholar 

  29. Hogan J, Chang KH, Duff G et al (2015) Lymphovascular invasion: a comprehensive appraisal in colon and rectal adenocarcinoma. Dis Colon Rectum 58:547–555

    Article  PubMed  Google Scholar 

  30. Anthony T, Simmang C, Hyman N et al (2004) Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum 47:807–817

    Article  PubMed  Google Scholar 

  31. Desch CE, Benson AB 3rd, Somerfield MR et al (2005) Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 23:8512–8519

    Article  PubMed  Google Scholar 

  32. Hallet J, Zih F, Lemke M et al (2014) Neo-adjuvant chemotherapy and multivisceral resection to optimize R0 resection of locally recurrent adherent colon cancer. Eur J Surg Oncol 40:706–712

    CAS  Article  PubMed  Google Scholar 

  33. Taylor W, Donohue J et al (2002) The mayo clinic experience with mutimodality treatment of locally advanced or recurrent colon cancer. Ann Surg Oncol 9:177–185

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors express their gratitude to Chan Wook Kim, M.D., Ph.D., Jong Lyul Lee, M.D. for their help with the statistical analysis and acquisition of data.

Author information

Affiliations

  1. Department of Surgery, Haeundae Paik Hospital, College of Medicine, University of Inje, Busan, Republic of Korea

    Won Beom Jung

  2. Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul, 05505, Republic of Korea

    Chang Sik Yu, Seok Byung Lim, In Ja Park, Yong Sik Yoon & Jin Cheon Kim

Authors
  1. Won Beom Jung
    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. Seok Byung Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In Ja Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong Sik Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin Cheon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang Sik Yu.

Ethics declarations

Conflicts of interest

The authors declare no competing interests in relation to this study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jung, W.B., Yu, C.S., Lim, S.B. et al. Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41, 285–294 (2017). https://doi.org/10.1007/s00268-016-3663-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3663-2

Keywords

  • Rectal Cancer
  • Curative Resection
  • Rectal Cancer Patient
  • Circumferential Resection Margin
  • Tumor Regression Grade