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Incidence and patterns of recurrence following curative resection for colorectal carcinoma

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Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was designed to determine incidence and patterns of recurrence after curative resection of colorectal carcinoma and to determine which variables are significant in predicting outcome. METHOD: A retrospective review of 524 patients operated on by one surgeon from 1975 to 1992 was conducted. Variables recorded included age, gender, location, gross morphology, histology, stage of each primary and evidence of perforation and direct extension at time of original operation. Overall survival and pattern of recurrence were documented. RESULTS: Overall recurrence rate was 27.9 percent. Anastomotic recurrence rate was 11.7 percent. Anastomotic recurrences were higher for rectal than colon lesions (20.3 vs. 6.2 percent;P = 0.001). Distant metastases developed in 14.4 percent of patients, 13.9 percent for colon carcinoma and 15.5 percent for rectal carcinoma. Average time for anastomotic recurrence was 16.2 months vs. 22.9 months for distant disease. T1,2,N0,M0 lesions had a 17.6 percent recurrence rate, T3,N0,M0 was 23.4 percent, and T1,2,3,N1,M0 was 43.7 percent (P =.001). Patients who did not undergo any intervention after diagnosis of recurrence survived an average of 28 months. Those who received palliative treatment survived an average of 39 months. Twenty-four percent of patients had reresection for cure, and 47 percent of these patients were alive at a mean of 80 months; those who died of their disease did so at an average of 53 months. Positive predictive factors for recurrence include site of lesion (rectum vs. colon), stage, invasion of contiguous organs, and presence of perforation. Age, gender, degree of differentiation, mucin secretion, and gross morphology were not found to be predictive factors in this study. CONCLUSIONS: Recurrence after resection for rectal carcinoma is higher than after colon carcinoma. In those patients in whom reresection is possible, up to 50 percent may have long-term survival. Understanding patterns of recurrence and features that predispose to them may guide the physician in aggressive but more selective adjuvant therapy and recommendations for targeted surveillance in follow-up.

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References

  1. Carlsson U, Lasson Å, Ekelund G. Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 1987;30:431–4.

    PubMed  Google Scholar 

  2. 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;174:27–32.

    PubMed  Google Scholar 

  3. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision and rectal cancer. Lancet 1986;1:1479–82.

    PubMed  Google Scholar 

  4. Stipa S, Nicolant V, Botti C,et al. Local recurrence after curative resection for colorectal cancer: frequency, risk factors and treatment. J Surg Oncol 1991;(Suppl 2):155–60.

    Google Scholar 

  5. Michelassi F, Vannucci L, Ayala JJ, Chappel R, Goldberg R, Block GE. Local recurrence after curative resection of colorectal adenocarcinoma. Surgery 1990;108:787–92.

    PubMed  Google Scholar 

  6. Dukes CE. The classificatin of cancer of the rectum. J Pathol Bacteriol 1932;35:323–32.

    Google Scholar 

  7. Kyzer S, Begin LR, Gordon PH, Mitmaker B. The care of patients with colorecal polyps that contain invasive adenocarcinoma. Cancer 1992;70:2044–50.

    PubMed  Google Scholar 

  8. Colton T. Statistics in medicine. Boston: Little Brown & Co., 1974.

    Google Scholar 

  9. Cox DR. Regression models and life-tables. J R Stat Soc 1972;34:187–220.

    Google Scholar 

  10. Kaplan EL, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc 1958;53:457–81.

    Google Scholar 

  11. Brister SJ, de Varennes B, Gordon PH, Sheiner NM, Pym J. Contemporary operative management of pulmonary metastases of colorectal origin. Dis Colon Rectum 1988;31:786–92.

    PubMed  Google Scholar 

  12. Hannanel N, Garzon J, Gordon PH. Hepatic resectin for colorectal liver metastases. Am Surgeon 1995;61:444–7.

    PubMed  Google Scholar 

  13. Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 1994;81:7–19.

    PubMed  Google Scholar 

  14. Malcolm AW, Perencevich NP, Olson RM, Hanley JA, Wilson RE. Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum. Surg Gynecol Obstet 1981;152:131–6.

    PubMed  Google Scholar 

  15. Devesa JM, Morales V, Enriquez JM,et al. Colorectal cancer: the bases for a comprehensive follow-up. Dis Colon Rectum 1988;31:636–52.

    PubMed  Google Scholar 

  16. Cass AW, Millian RR, Pfaff WW. Patterns of recurrence following surgery along for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–5.

    PubMed  Google Scholar 

  17. Umpleby HC, Williamson RC. Anastomotic recurrence in large bowel cancer. Br J Surg 1987;74:873–8.

    PubMed  Google Scholar 

  18. Rodriguez-Bigas MA, Stulc JP, Davidson BD, Petrelli NJ. Prognostic significance of anastomotic recurrence from colorectal adenocarcinoma. Dis Colon Rectum 1992;35:838–42.

    PubMed  Google Scholar 

  19. Bentzen SM, Balslev I, Pederson M,et al. Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy: a multivariate regression analysis. Br J Cancer 1992;65:102–7.

    PubMed  Google Scholar 

  20. Neville R, Fielding LP, Amendola C. Local tumor recurrence after curative resection for rectal cancer: a tenhospital review. Dis Colon Rectum 1986;30:12–7.

    Google Scholar 

  21. Deans GT, Heatley M, Anderson N,et al. Jass' classification revisited. J Am Coll Surg 1994;179:11–7.

    PubMed  Google Scholar 

  22. Gordon PH. Malignant neoplasms of the colon. In: Gordon PH, Nivatvongs S, eds. Principles and practice of surgery for the colon, rectum, and anus. St. Louis: Quality Medical Publishing, 1992:501–90.

    Google Scholar 

  23. Hannisdal E, Thorsen G. Regression analyses of prognostic factors in colorectal cancer. J Surg Oncol 1988;37:109–12.

    PubMed  Google Scholar 

  24. Duncan W, Smith AN, Freedman LF,et al. Clinicopathological features of prognostic significance inoperable rectal cancer in 17 centres in the U. K. Br J Cancer 1984;50:435–42.

    PubMed  Google Scholar 

  25. Griffin MR, Bergstralh EJ, Coffey RJ, Beart RW, Melton LJ. Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 1987;60:2318–24.

    PubMed  Google Scholar 

  26. Deans GT, Patterson CC, Parks TG,et al. Colorectal carcinoma: importance of clinical and pathological factors in survival. Ann R Coll Surg Engl 1994;76:59–64.

    Google Scholar 

  27. Crucitti F, Sofo L, Doglietto GB,et al. Prognostic factors in clorectal cancer: current status and new trends. J Surg Oncol 1991;2:76–82.

    Google Scholar 

  28. Godwin JD, Brown CC. Some prognostic factors in survival of patients with cancer of the colon and rectum. J Chronic Dis 1975;28:441–54.

    PubMed  Google Scholar 

  29. Russell A, Tong D, Dawson LE,et al. Adenocarcinoma of the proximal colon: sites of initial dissemination and patterns of recurrence following surgery alone. Cancer 1984;53:360–7.

    PubMed  Google Scholar 

  30. Pellicer E, Parrilla P, Aguilar J,et al. Patterns of recurrence following surgery for carcinoma of the colon and rectum. Br J Surg 1993;(Suppl 80):S23.

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Quebec, Canada

    Daniel I. Obrand M.D. & Philip H. Gordon M.D.

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  1. Daniel I. Obrand M.D.
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  2. Philip H. Gordon M.D.
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Supported by the Sir Mortimer B. Davis-Jewish General Hospital Foundation, Montreal, Quebec, Canada.

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Obrand, D.I., Gordon, P.H. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum 40, 15–24 (1997). https://doi.org/10.1007/BF02055676

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