Abstract
Background
Locoregional recurrence (LR) in colon cancer is uncommon but often incurable, while the factors associated with it are unclear. The purpose of this study was to identify patterns and predictors of LR after curative resection for colon cancer.
Methods
All patients who underwent colon cancer resection with curative intent between 1994 and 2008 at a tertiary referral center were identified from a prospectively maintained institutional database. The association of LR with clinicopathologic and treatment characteristics was determined using univariable and multivariable analyses.
Results
A total of 1397 patients were included with a median follow-up of 7.8 years; 635 (45%) were female, and the median age was 69 years. LR was detected in 61 (4.4%) patients. Median time to LR was 21 months. On multivariable analysis, the independent predictors of LR were disease stage [hazard ratio (HR) for Stage II 4.6, 95% confidence interval (CI) 1.05–19.9, HR for Stage III 10.8, 95% CI 2.6–45.8], bowel obstruction (HR 3.8, 95% CI 1.9–7.4), margin involvement (HR 4.1, 95% CI 1.9–8.6), lymphovascular invasion (HR 1.9, 95% CI 1.06–3.5), and local tumor invasion (fixation to another structure, perforation, or presence of associated fistula, HR 2.2, 95% CI 1.1–4.5). Adjuvant chemotherapy was not associated with reduced LR in patients with either Stage II or Stage III tumors.
Conclusions
Adherence to oncologic surgical principles in colon cancer resection results in low rates of LR, which is associated with tumor-dependent factors. Recognition of these factors can help to determine appropriate postoperative surveillance.
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References
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.
Read TE, Mutch MG, Chang BW, et al. Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg. 2002;195(1):33–40.
Sjovall A, Granath F, Cedermark B, Glimelius B, Holm T. Loco-regional recurrence from colon cancer: a population-based study. Ann Surg Oncol. 2007;14(2):432–40.
Elferink MA, Visser O, Wiggers T, et al. Prognostic factors for locoregional recurrences in colon cancer. Ann Surg Oncol. 2012;19(7):2203–11.
Dorrance HR, Docherty GM, O’Dwyer PJ. Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery. Dis Colon Rectum. 2000;43(4):492–8.
Harris GJ, Church JM, Senagore AJ, et al. Factors affecting local recurrence of colonic adenocarcinoma. Dis Colon Rectum. 2002;45(8):1029–34.
Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg. 2006;93(9):1115–22.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998;133(8):894–9.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.
Birgisson H, Talback M, Gunnarsson U, Pahlman L, Glimelius B. Improved survival in cancer of the colon and rectum in Sweden. Eur J Surg Oncol. 2005;31(8):845–53.
Lemmens V, van Steenbergen L, Janssen-Heijnen M, Martijn H, Rutten H, Coebergh JW. Trends in colorectal cancer in the south of the Netherlands 1975–2007: rectal cancer survival levels with colon cancer survival. Acta Oncol. 2010;49(6):784–96.
Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007. doi:10.1002/14651858.CD002200.pub2.
Meyerhardt JA, Mangu PB, Flynn PJ, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31(35):4465–70.
Turnbull RB Jr, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg. 1967;166(3):420–7.
Bowne WB, Lee B, Wong WD, et al. Operative salvage for locoregional recurrent colon cancer after curative resection: an analysis of 100 cases. Dis Colon Rectum. 2005;48(5):897–909.
Galandiuk S, Wieand HS, Moertel CG, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet. 1992;174(1):27–32.
Network NCC. Clinical Practice Guidelines in Oncology (NCCN Guidelines): Colon Cancer, Version 3.2014. Vol 20142014.
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis. 2009;11(4):354–64; discussion 364-5.
Kessler H, Hohenberger W. Extended lymphadenectomy in colon cancer is crucial. World J Surg. 2013;37(8):1789–98.
Kobayashi H, West NP, Takahashi K, et al. Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan. Ann Surg Oncol. 2014;21 Suppl 3:S398–404.
West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28(2):272–8.
Abbas MA, Chang GJ, Read TE, et al. Optimizing rectal cancer management: analysis of current evidence. Dis Colon Rectum. 2014;57(2):252–9.
Martling A, Holm T, Rutqvist LE, et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. Br J Surg. 2005;92(2):225–9.
Nedrebo BS, Soreide K, Eriksen MT, et al. Survival effect of implementing national treatment strategies for curatively resected colonic and rectal cancer. Br J Surg. 2011;98(5):716–23.
Stocchi L, Nelson H, Sargent DJ, et al. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol. 2001;19(18):3895–902.
Madoff RD. Defining quality in colon cancer surgery. J Clin Oncol. 2012;30(15):1738–40.
Kessler H, Mansmann U, Hermanek Jr P, Riedl S, Hermanek P. Does the Surgeon Affect Outcome in Colon Carcinoma? Semin Colon Rectal Surg. 1998;9(4):233–40.
West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9(9):857–65.
Primrose JN, Perera R, Gray A, et al. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA. 2014;311(3):263–70.
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Liska, D., Stocchi, L., Karagkounis, G. et al. Incidence, Patterns, and Predictors of Locoregional Recurrence in Colon Cancer. Ann Surg Oncol 24, 1093–1099 (2017). https://doi.org/10.1245/s10434-016-5643-z
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DOI: https://doi.org/10.1245/s10434-016-5643-z