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Revised guidelines for second-look surgery in patients with colon and rectal cancer

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Abstract

Proper indications for a second surgical intervention in patients with colorectal cancer have always been a controversial subject. Surgeons find benefit in a second-look operation where a limited extent of cancer is discovered and resected with negative margins. However, a negative exploratory laparotomy or an intervention that is unable to achieve an R0 resection provides little or no benefit. Unfortunately, this type of intervention may place the patient in a worse condition, leading to morbidity or mortality. This manuscript attempts to define clinical parameters of primary colorectal cancer that are associated with a pattern of recurrence and that can be definitively addressed by second-look surgery. Also, new surgical technologies that may assist in achieving a potentially curative resection of local-regional recurrence are described. Cytoreductive surgery with peritonectomy and perioperative intraperitoneal chemotherapy with hyperthermia is presented as a new treatment option for reoperative surgery. A new management plan utilized in patients at high risk for local-regional recurrence may result in a high likelihood of conversion of a second-look cancer-positive patient to a long-term survivor.

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References

  1. Osteen RT, Guyton S, Steele G Jr, Wilson RE (1980) Malignant intestinal obstruction. Surgery 87:611–615

    CAS  PubMed  Google Scholar 

  2. Walsh HPJ, Schofield PF (1984) Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy? Br J Surg 71: 933–935

    Article  CAS  PubMed  Google Scholar 

  3. Spears H, Petrelli NJ, Herrera L, Mittelman A (1998) Treatment of bowel obstruction after operation for colorectal carcinoma. Am J Surg 155: 383–386

    Article  Google Scholar 

  4. Butler JA, Cameron BL, Morrow M, Kahng K et al (1991) Small bowel obstruction in patients with a prior history of cancer. Am J Surg 162:624–628

    Article  CAS  PubMed  Google Scholar 

  5. Gwin JL, Hoffman JP, Eisenberg BL (1993) Surgical management of nonhepatic intra-abdominal recurrence of carcinoma of the colon. Dis Colon Rectum 36:540–544

    Article  CAS  PubMed  Google Scholar 

  6. Gilbertsen VA, Wangensteen OH (1962) A summary of thirteen years’ experience with the second look program. Surg Gynecol Obstet 114:438–442

    CAS  PubMed  Google Scholar 

  7. Minton JP, Hoehn JL, Gerber DM et al (1985) Results of a 400-patient carcinoembryonic antigen second-look colorectal cancer study. Cancer 55: 1284–1290

    Article  CAS  PubMed  Google Scholar 

  8. Griffen WO Jr, Humphrey L, Sosin H (1969) The prognosis and management of recurrent abdominal malignancies. Curr Probl Surg Apr:1–43

  9. Wangensteen OH (1949) Cancer of the colon and rectum; with special reference to earlier recognition of alimentary tract malignancy; secondary delayed re-entry of the abdomen in patients exhibiting lymph node involvement; subtotal primary excision of the colon; operation in obstruction. Wis Med J 48:591–597

    CAS  PubMed  Google Scholar 

  10. Sugarbaker PH, Zamcheck N, Moore FD (1976) Assessment of serial carcinoembryonic antigen (CEA) assays in postoperative detection of recurrent colorectal cancer. Cancer 38:2310–2315

    Article  CAS  PubMed  Google Scholar 

  11. Steele G Jr, Zamcheck N, Wilson R et al (1980) Results of CEA-initiated second-look surgery for recurrent colon cancer. Am J Surg 139:544–548

    Article  PubMed  Google Scholar 

  12. Attiyeh FF, Stearns MW Jr (1981) Second-look laparotomy based on CEA elevations in colorectal cancer. Cancer 47:2119–2125

    Article  CAS  PubMed  Google Scholar 

  13. Goldberg RM, Fleming TR, Tangen CM et al (1998) Surgery for recurrent colon cancer: Strategies for identifying resectable recurrence and success rates after resection. Ann Intern Med 129: 27–35

    CAS  PubMed  Google Scholar 

  14. Gunderson LL, Sosin H (1974) Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer 34: 1278–1292

    Article  CAS  PubMed  Google Scholar 

  15. Lofgren EP, Waugh JM, Dockerty MB (1957) Local recurrence of carcinoma after anterior resection of the rectum and the sigmoid. Arch Surg 74: 825–838

    CAS  Google Scholar 

  16. Turnbull RB, Kyle K, Watson FR et al (1967) Cancer of the colon: The influence of the no-touch isolation technic on survival rates. Ann Surg 166: 420–427

    Article  PubMed  Google Scholar 

  17. Haugstvedt TK, Viste A, Eide GE et al (1993) Norwegian multicentre study of survival and prognostic factors in patients undergoing curative resection for gastric carcinoma. Br J Surg 80:475–478

    Article  CAS  PubMed  Google Scholar 

  18. Sugarbaker PH, Gianola FJ, Speyer JL et al (1985) Prospective randomized trial of intravenous versus intraperitoneal 5 fluorouracil in patients with advanced primary colon or rectal cancer. Surgery 98:414–421

    CAS  PubMed  Google Scholar 

  19. Sugarbaker PH (1996) Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology. In: Sugarbaker PH (ed). Peritoneal carcinomatosis: principles of management. Kluwer, Boston, pp 79–100

    Google Scholar 

  20. Alexander HR, Allegra CJ, Lawrence TS (2001) Metastatic cancer to the liver. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer: principles & practice of oncology, 6th edn. Lippincott, Philadelphia, pp 2690–2713

    Google Scholar 

  21. Yan TD, Black D, Savady R et al (2006) Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol 24:4011–4019

    Article  PubMed  Google Scholar 

  22. Elias D, Gilly F, Boutitie F et al (2009) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 28:63–68

    Article  PubMed  Google Scholar 

  23. Swanson RS, Compton CC, Stewart AK et al (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65

    Article  PubMed  Google Scholar 

  24. Rich T, Gunderson LL, Galdabini J et al (1983) Clinical and pathologic factors influencing local failure after curative resection of carcinoma of the rectum and rectosigmoid. Cancer 52:1317–1327

    Article  CAS  PubMed  Google Scholar 

  25. Sugarbaker PH (1999) Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol 43(Suppl):S15–S25

    Article  PubMed  Google Scholar 

  26. Sugarbaker PH, Gunderson LL, Wittes RE (1985) Colorectal cancer. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, Vol. 1, 2nd edn. JB Lippincott, Philadelphia, pp 795–866

    Google Scholar 

  27. Rekhraj S, Aziz O, Prabhudesai S et al (2007) Can intra-operative intraperitoneal free cancer cell detection techniques identify patients at higher recurrence risk following curative colorectal cancer resection: A meta-analysis. Ann Surg Oncol 15:60–68

    Article  PubMed  Google Scholar 

  28. da Silva RG, Sugarbaker PH (2006) Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. J Am Coll Surg 203:878–886

    Article  PubMed  Google Scholar 

  29. Sugarbaker PH, Jablonski KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221:124–132

    Article  CAS  PubMed  Google Scholar 

  30. Elias D, Goere D, Di Pietrantonio D et al (2008) Results of systematic second-look surgery in pts at high risk of developing colorectal peritoneal carcinomatosis. Ann Surg 247:445–450

    Article  PubMed  Google Scholar 

  31. Sugarbaker PH (2008) Options for the management of peritoneal carcinomatosis, patients have the right to be informed. Leadership Medica 269:28–35

    Google Scholar 

  32. Sugarbaker PH (2008) Comprehensive management of disseminated colorectal cancer. Ann Surg Oncol 15:3327–3330

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Washington Cancer Institute, 106 Irving St., NW, Suite 3900, Washington, DC, 20010, USA

    Paul H. Sugarbaker

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  1. Paul H. Sugarbaker
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Correspondence to Paul H. Sugarbaker.

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Sugarbaker, P.H. Revised guidelines for second-look surgery in patients with colon and rectal cancer. Clin Transl Oncol 12, 621–628 (2010). https://doi.org/10.1007/s12094-010-0567-8

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  • DOI: https://doi.org/10.1007/s12094-010-0567-8

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