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Rectal Cancer Surveillance—Recurrence Patterns and Survival Outcomes from a Cohort Followed up Beyond 10 Years

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Abstract

Aim

The intensity and duration of surveillance for rectal cancer after surgical resection remain contentious. We evaluated the pattern of recurrences in a rectal cancer cohort followed up beyond 10 years.

Methods

An analysis was performed on a retrospective database of 326 patients with rectal cancer who underwent curative surgical resection from 1999 to 2007. The above study duration was chosen to ensure at least 10 years of follow-up. Data on patient demographics, peri-operative details, and follow-up outcomes were extracted from the database. The pattern of recurrences and investigative modality that detected recurrences was identified. Patients were followed up until either year 2016 or the day of their demise.

Results

Two hundred seventeen patients (66.6%) were male and 109 patients (33.3%) female. Median age was 64 years old. Close to a third of the patients received adjuvant therapy (34%). Among the 326 patients studied, 29.8% of (97/326) patients developed recurrence. 7.7% (25/326) had loco-regional recurrence while 22.1% (72/326) had distant metastasis. Median time to recurrence was 16 months (4–83) and 18 months (3–81), respectively. Computed tomography scan was the best modality to detect both loco-regional and distant recurrences (48% in loco-regional and 41.7% in distant metastasis). The most common site of distant metastasis is the lung (34.7%). The salvage rate for loco-regional and distant recurrences was 52 and 12.5%, respectively.

Conclusion

The predominant pattern of recurrence in rectal cancer is distant disease. Surveillance regimes may need to be altered to increase early detection of distant metastases.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore

    Winson Jianhong Tan, Hiang Jin Tan, Fung Joon Foo, Choong Leong Tang & Min Hoe Chew

  2. Department of Pharmacy, National University of Singapore, Singapore, Singapore

    Sreemanee Raaj Dorajoo

Authors
  1. Winson Jianhong Tan
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  2. Hiang Jin Tan
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  3. Sreemanee Raaj Dorajoo
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  4. Fung Joon Foo
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  5. Choong Leong Tang
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  6. Min Hoe Chew
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Correspondence to Min Hoe Chew.

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The authors declare that they have no conflict of interest.

Additional information

What does this paper add to the literature:

This paper studies a cohort of rectal cancer patients who have been followed up beyond 10 years after curative surgery. It provides insight on the incidence of recurrences beyond the usual 5-year follow-up duration and the recurrence patterns of rectal cancer to allow modifications of current surveillance regimes.

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Tan, W.J., Tan, H.J., Dorajoo, S.R. et al. Rectal Cancer Surveillance—Recurrence Patterns and Survival Outcomes from a Cohort Followed up Beyond 10 Years. J Gastrointest Canc 49, 422–428 (2018). https://doi.org/10.1007/s12029-017-9984-z

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  • DOI: https://doi.org/10.1007/s12029-017-9984-z

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