Local recurrence after curative resection for colorectal cancer: Frequency, risk factors and treatment

Abstract

Analysis of 498 patients with colorectal carcinoma was retrospectively reviewed to evaluate the incidence, risk factors and therapy of local recurrent carcinoma following curative resection. Complete follow-up information was obtained in all but four patients (99.2%). After a median follow up of 42 months, 64 out of 469 (13.6%) patients developed local recurrence (LR). The incidence of LR was higher in rectal than in colon cancer patients (18.3% vs 8.9%) ( P < 0.005). Separate univariate and Cox analyses for rectal patients showed tumor site ( P < 0.02). Dukes stage ( P < 0.002), and adjuvant radiotherapy ( P = 0.05) determined risk of LR. For colon cancer patients risk of LR was determined by histological tumor grade ( P < 0.01). Out of 64 patients, 5 (7.8%) underwent radical excision of LR. Forty percent of these survived at 5-year (P < 0.08).Palliative treatment (radio-chemotherapy) obtained a 5-year survival of 15.3%, with no survivors in no-treatment group. These results suggest that local recurrent colorectal carcinoma remain a difficult treatment problem. More effective combinations of surgery and adjuvant therapy are therefore mandatory to reduce the incidence of local failure in high risk colorectal patients.KEY WORDS: colorectal cancer, local recurrence, risk factors, adjuvant radiotherapy, Dukes staging From 1970From to 1990 patients affected with large bowel adenocarcinoma who were referred to the two senior authors (S.S., R.C.) have been treated with PATIENTS AND METHODS

Feasibility and Early Results of Interstitial Intensity-Modulated HDR/PDR Brachytherapy (IMBT) with/without Complementary External-Beam Radiotherapy and Extended Surgery in Recurrent Pelvic Colorectal Cancer

“…It is generally accepted that the best approach for long-term survival in local recurrence is extensive surgical resection whenever possible [23,27], for which 5-year survival rates of 19-30% have been reported [11,23,28]. Complete resection is of paramount importance to achieve these excellent results [6,18,26]. Nevertheless, in many patients this is hardly possible and might require sacral resection, which is associated with a high complication rate and poor wound healing [29,30].…”

Preoperative serum CD26 levels: diagnostic efficiency and predictive value for colorectal cancer

“…Our conclusion is that preoperative sCD26 level is an useful, easy to handle marker for early detection of potentially curable CRC. Reported recurrence rates after curative resection of largebowel adenocarcinoma varied widely, partly because of how a recurrence is defined (Stipa et al, 1991), from 3% to 50%, usually within 2 years of surgery. As the risk factors commonly identified (level of invasion, lymphatic involvement, and site of original carcinoma) (Michelassi et al, 1990) do not always allow prediction of the outcome, which may guide the physician in aggressive but more selective adjuvant therapy and targeted surveillance in follow-up (Obrand and Gordon, 1997), we also studied if CD26 can help to distinguish CRC cases at high risk of tumour recurrence.…”

Surveillance of patients following surgery with curative intent for colorectal cancer

“…Detecting recurrent disease is only useful if early treatment leads to an improved prognosis. Although the majority of relapsing patients are incurable, around one third of patients with isolated distant or locoregional recurrence are alive at 5 years after treatment, and long-term survival is possible [21,[23][24][25][26][27][28][29][30][31][32][33] . Rates of resection for isolated or limited disease recurrence have increased, and approximately 20% of patients with hepatic relapse are currently considered for surgery [24,32,34] .…”