Operative salvage for locoregional recurrent colon cancer after curative resection: An analysis of 100 cases Journal Article
| Authors: | Bowne, W. B.; Lee, B.; Wong, W. D.; Ben-Porat, L.; Shia, J.; Cohen, A. M.; Enker, W. E.; Guillem, J. G.; Paty, P. B.; Weiser, M. R. |
| Article Title: | Operative salvage for locoregional recurrent colon cancer after curative resection: An analysis of 100 cases |
| Abstract: | PURPOSE: Locoregional recurrence after resection of colon carcinoma is an uncommon and difficult clinical problem. Outcome data to guide surgical management are limited. This investigation was undertaken to review our experience with surgical resection for patients with locoregional recurrence colon cancer, determine predictors of respectability, and define prognostic factors associated with survival. PATIENTS AND METHODS: A prospective database was queried for patients who had recurrent colon cancer between January 1991 and October 2002. Patients were selected for analysis if they had either isolated resectable locoregional recurrence or concomitant resectable distant disease. Disease-specific survival analysis was performed with the Kaplan-Meier actuarial method, and factors associated with outcome were determined by the log-rank test and Cox regression. RESULTS: During this period of time, 744 patients with recurrent colon cancer were identified and 100 (13.4 percent) underwent exploration with curative intent for potentially resectable locoregional recurrence: 75 with isolated locoregional recurrence, and 25 with locoregional recurrence and resectable distant disease. The median follow-up for survivors was 27 months. Locoregional recurrence was classified into four categories: anastomotic; mesenteric/nodal; retroperitoneal; and peritoneal. Median survival for all patients was 30 months. Fifty-six patients had an R0 resection (including distant sites). Factors associated with prolonged disease-specific survival included R0 resection (P < 0.001); age <60 years (P < 0.01); early stage of primary disease (P = 0.05); and no associated distant disease (P = 0.03). Poor prognostic factors included more than one site of recurrence (P = 0.05) and involvement of the mesentery/nodal basin (P = 0.03). The ability to obtain an R0 resection was the strongest predictor of outcome, and these patients had a median survival of 66 months. CONCLUSION: Salvage surgery for locoregional recurrence colon cancer is appropriate for select patients. Complete resection is critical to long-term survival and is associated with a single site of recurrence, perianastomotic disease, low presalvage carcinembryonic antigen level, and absence of distant disease. © The American Society of Colon and Rectal Surgeons. |
| Keywords: | survival; adult; cancer chemotherapy; cancer survival; treatment outcome; aged; disease-free survival; middle aged; survival analysis; cancer surgery; major clinical study; clinical trial; review; salvage therapy; fluorouracil; cancer radiotherapy; disease free survival; cancer staging; recurrent cancer; follow up; neoplasm staging; prospective study; prospective studies; peritoneum cancer; neoplasm recurrence, local; proportional hazards models; colonic neoplasms; recurrence; pathology; data base; prediction; proportional hazards model; tumor recurrence; colon cancer; colon tumor; surgery; colon resection; kaplan meier method; regression analysis; salvage; retroperitoneal cancer; colectomy; locoregional; mesentery tumor |
| Journal Title: | Diseases of the Colon and Rectum |
| Volume: | 48 |
| Issue: | 5 |
| ISSN: | 0012-3706 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2005-05-01 |
| Start Page: | 897 |
| End Page: | 909 |
| Language: | English |
| DOI: | 10.1007/s10350-004-0881-8 |
| PROVIDER: | scopus |
| PUBMED: | 15785892 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 31" - "Export Date: 24 October 2012" - "CODEN: DICRA" - "Source: Scopus" |
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