Abstract
The reported low resectability rate for patients with recurrent colorectal cancer who have carcinoembryonic antigen (CEA) levels >11 has led us to perform this study. One hundred twenty-four patients who underwent Radioimmunoguided Surgery ® (RIGS ®)procedures for recurrent colorectal cancer from 1986 to the present were studied. In surgery, all patients underwent a traditional exploration followed by survey with a hand-held, gamma-detecting probe to detect preinjected radiolabeled monoclonal antibodies attached to cancer cells. Sites of metastases included: 72 liver (58.1 percent), 23 pelvis (18.5 percent), 15 distant lymph nodes (12.1 percent), 2 anastomotic (1.6 percent), and 12 other sites (9.7 percent). The resectability rate was 43.5 percent (54 patients). The mean preoperative CEA level for patients with resectable disease was significantly lower than for patients with unresectable disease (P=0.017): unresectable—mean, 87.1; SD, 141.0; minimum, 0.3; maximum, 501; resectable—mean, 36.6; SD, 59.3; minimum, 0.3; maximum, 329. The CEA level for patients with liver metastasis did not vary significantly from those patients without metastasis: 70 vs. 58.2 (P=0.58). Those patients with resectable liver tumors had lower mean CEA levels than those with unresectable liver, approaching significance: 41.6 vs. 91.9 (P=0.065). Other metastatic sites had a mean CEA level of: pelvic, 72.6; distant lymph nodes, 47.8; anastomotic, 2.7; and other sites, 53.8. These data suggest that there is a significant difference between the preoperative CEA level of the resectable and unresectable recurrent colorectal cancer patients, but the large standard deviation does not justify abandonment of exploration for any CEA level.
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References
Wangensteen OH, Lewis FJ, Tongen LA. The “second-look” in cancer surgery: a patient with colic cancer and involved lymph nodes negative on the “sixth look”. Lancet 1951;2:303–7.
Griffen WO Jr, Humphrey L, Sosin H. The prognosis and management of recurrent abdominal malignancies. Curr Probl Surg 1969;6:32–43.
Martin EW, James KK, Hurtubise PE, Gatalano P, Minton JP. The use of CEA as an early indicator for gastrointestinal tumor recurrence and second-look procedures. Cancer 1977;39:440–6.
Minton JP, Hoehn IL, Gerber DM,et al. Results of a 400-patient carcinoembryonic antigen second look colorectal cancer study. Cancer 1985;55:1284–90.
Martin EW, Mojzisik CM, Hinkle GH,et al. Radioimmunoguided surgery using monoclonal antibody. Am J Surg 1988;156:386–92.
Martin EW, Carey LC. Second-look surgery for colorectal cancer: the second time around. Ann Surg 1991;214:321–7.
Cohen AM, Martin EW, Lavery I,et al. Radioimmunoguided surgery using iodine 125 B72.3 in patients with colorectal cancer. Arch Surg 1991;126:349–52.
Siegel S. Nonparametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956:42–7, 116–27.
Fletcher RH. Carcinoembryonic antigen. Ann Intern Med 1986;104:66–73.
Thomas P, Toth CA, Saini KS, Jessup JM, Steele G Jr. The structure, metabolism and function of the carcinoembryonic antigen gene family. Biochim Biophys Acta 1990;1032:177–89.
Gold P, Freedman SO. Demonstration of tumor specific antigen in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med 1965;121:439–62.
Wanebo HJ, Rao B, Pinsky CM,et al. Preoperative carcinoembryonic antigen level as prognostic indicator in colorectal cancer. N Engl J Med 1978;299:448–51.
Fantini GA, DeCosse JJ. Surveillance strategies after resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1990;171:267–73.
Martin EW, Cooperman M, Carey LC, Minton JP. Sixty second-look procedures indicated primarily by rise in serial carcinoembryonic antigen. J Surg Res 1980;28:389–94.
Sardi A. Multiple operations for recurrent colorectal cancer. Semin Surg Oncol 1991;7:146–56.
Staab HJ, Anderer FA, Stumpf E, Fischer R. Slope analysis of the postoperative CEA time course and its possible application as an aid in diagnosis of disease progression in gastrointestinal cancer. Am J Surg 1978;136:322–7.
Martin EW, Minton JP, Carrey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 1985;202:310–7.
Gunderson LL, Tepper JE, Dosoretz DE,et al. Patterns of failure after treatment of gastrointestinal cancer. Cancer Treat Symp 1983;2:181–97.
Hughes HS, Sugarbaker PH. Resection of the liver for metastatic solid tumors. In: Rosenberg SA, ed. Surgical treatment of metastatic cancer. Philadelphia: JB Lippincott, 1987:125–64.
Schneebaum S, Arnold MW, Rohrscheib S,et al. The importance of intraoperative periportal lymph metastasis identification. 40th Annual Cancer Symposium S.S.O., 1992:134 (Abstr.).
Tabuchi Y, Deguchi H, Imanishi K, Saitoh Y. Colorectal cancer patients with high risk of hematogenous metastasis: correlation with CEA levels in peripheral and draining venous blood during the period of operation. J Surg Oncol 1991;47:87–91.
Cady B, Stone MD, McDermott WV Jr,et al. Technical and biological factors in disease-free survival after hepatic resection for colorectal cancer metastases. Arch Surg 1992;127:561–9.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.
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Schneebaum, S., Arnold, M.W., Young, D. et al. Role of carcinoembryonic antigen in predicting resectability of recurrent colorectal cancer. Dis Colon Rectum 36, 810–815 (1993). https://doi.org/10.1007/BF02047376
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DOI: https://doi.org/10.1007/BF02047376