 |
 |
|
1 July 1998 | Volume 129 Issue 1 | Pages 27-35
Background: Follow-up testing after surgery for colon cancer is recommended principally to identify resectable recurrences, but data on the efficacy of, outcomes of, and optimal strategies for this testing are limited.
Objectives: To determine the relation between follow-up tests and salvage surgery, assess outcomes, and document surgical mortality.
Design: Retrospective cohort study.
Setting: A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone.
Patients: 1247 patients with resected stage II and stage III colon cancer.
Intervention: The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented.
Measurements: Recurrence, resectable recurrence, surgical mortality, and survival were studied.
Results: 548 patients had recurrence of colon cancer. Salvage surgery was attempted in 222 patients (41%). In 109 patients (20%), curative-intent surgery was done for hepatic recurrence (28 patients), pulmonary metastasis (20 patients), local recurrence (24 patients), or recurrence at other sites (37 patients). Most curative-intent surgical procedures were motivated by follow-up testing (36 patients), elevated carcinoembryonic antigen level (41 patients), or symptoms (27 patients). The median follow-up time after curative-intent surgery exceeded 5 years; the estimated 5-year disease-free survival rate was 23%. A solitary lesion was a favorable prognostic factor. The surgical mortality rate was 2%. Curative-intent resections were done in 15 patients with second primary colorectal cancer; 12 of these patients have survived disease-free.
Conclusions: Second operations for colon cancer that are triggered by follow-up testing or symptoms are common and can result in long-term disease-free survival.
Author and Article Information
For the Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group.
ARTICLE
Surgery for Recurrent Colon Cancer: Strategies for Identifying Resectable Recurrence and Success Rates after Resection
From the Mayo Clinic, Rochester, Minnesota; the Fred Hutchinson Cancer Research Center, Seattle, Washington; Temple University School of Medicine and the University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania; and Grand Forks Clinic, Grand Forks, North Dakota.
(Moertel) Deceased.
Acknowledgments: The authors thank John Van-Damme, BS, BA, from the Southwest Oncology Group; Deborah Papenfus from the North Central Cancer Treatment Group; the investigative teams from the North Central Treatment Group, the Southwest Oncology Group, and the Eastern Cooperative Oncology Group; and the patients who participated in the trial.
Grant Support: In part by grants CA-25224, CA-31224, and CA-37404 to the North Central Cancer Treatment Group; grants CA-32102, CA-37429, and CA-39091 to the Southwest Oncology Group; grants CA-21115, CA-37403, and CA-39088 to the Eastern Cooperative Oncology Group; and grants to individual participating institutions from the National Cancer Institute, National Institutes of Health, and Department of Health and Human Services.
Requests for Reprints: Richard M. Goldberg, MD, Division of Medical Oncology, Mayo Clinic E12, 200 First Street SW, Rochester, MN 55905; e-mail, goldberg.richard@mayo.edu.
Current Author Addresses: Dr. Goldberg: Division of Medical Oncology, Mayo Clinic E12, 200 First Street SW, Rochester, MN 55905.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  S.-m. Yie, B. Lou, S.-r. Ye, M. Cao, X. He, P. Li, K. Hu, L. Rao, S.-m. Wu, H.-b. Xiao, et al. Detection of Survivin-Expressing Circulating Cancer Cells (CCCs) in Peripheral Blood of Patients with Gastric and Colorectal Cancer Reveals High Risks of Relapse Ann. Surg. Oncol., November 1, 2008; 15(11): 3073 - 3082. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Scott, D. H. Gunawardana, B. Kelley, J. G. Stuckey, A. J. Byrne, J. E. Ramshaw, and M. J. Fulham PET Changes Management and Improves Prognostic Stratification in Patients with Recurrent Colorectal Cancer: Results of a Multicenter Prospective Study J. Nucl. Med., September 1, 2008; 49(9): 1451 - 1457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Iizasa, M. Suzuki, S. Yoshida, S. Motohashi, K. Yasufuku, A. Iyoda, K. Shibuya, K. Hiroshima, Y. Nakatani, and T. Fujisawa Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann. Thorac. Surg., July 1, 2006; 82(1): 254 - 260. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Giribaldi, S. Procida, D. Ulliers, F. Mannu, R. Volpatto, G. Mandili, L. Fanchini, O. Bertetto, G. Fronda, L. Simula, et al. Specific Detection of Cytokeratin 20-Positive Cells in Blood of Colorectal and Breast Cancer Patients by a High Sensitivity Real-Time Reverse Transcriptase-Polymerase Chain Reaction Method J. Mol. Diagn., February 1, 2006; 8(1): 105 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Goldberg Intensive Surveillance After Stage II or III Colorectal Cancer: Is It Worth It? J. Clin. Oncol., January 20, 2006; 24(3): 330 - 331. [Full Text] [PDF]
|
|
|
|
|
|
S. Sadahiro, T. Suzuki, K. Ishikawa, T. Saguchi, Y. Maeda, S. Yasuda, H. Makuuchi, S. Yurimoto, and C. Murayama Detection of Carcinoembryonic Antigen Messenger RNA-Expressing Cells in Portal and Peripheral Blood During Surgery Does Not Influence Relapse in Colorectal Cancer Ann. Surg. Oncol., December 1, 2005; 12(12): 988 - 994. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Mann, M. S. Metcalfe, L. N. Leopardi, and G. J. Maddern The Clinical Risk Score: Emerging as a Reliable Preoperative Prognostic Index in Hepatectomy for Colorectal Metastases Arch Surg, November 1, 2004; 139(11): 1168 - 1172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. A. Punt New options and old dilemmas in the treatment of patients with advanced colorectal cancer Ann. Onc., October 1, 2004; 15(10): 1453 - 1459. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Metcalfe, E. J. Mullin, and G. J. Maddern Choice of Surveillance After Hepatectomy for Colorectal Metastases Arch Surg, July 1, 2004; 139(7): 749 - 754. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Pfister, A. B. Benson III, and M. R. Somerfield Surveillance Strategies after Curative Treatment of Colorectal Cancer N. Engl. J. Med., June 3, 2004; 350(23): 2375 - 2382. [Full Text] [PDF]
|
|
|
|
|
|
I. Chau, M. J. Allen, D. Cunningham, A. R. Norman, G. Brown, H. E.R. Ford, N. Tebbutt, D. Tait, M. Hill, P. J. Ross, et al. The Value of Routine Serum Carcino-Embryonic Antigen Measurement and Computed Tomography in the Surveillance of Patients After Adjuvant Chemotherapy for Colorectal Cancer J. Clin. Oncol., April 15, 2004; 22(8): 1420 - 1429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. J. Verwaal, H. Boot, B. M. P. Aleman, H. van Tinteren, and F. A. N. Zoetmulder Recurrences after Peritoneal Carcinomatosis of Colorectal Origin Treated by Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy: Location, Treatment, and Outcome Ann. Surg. Oncol., April 1, 2004; 11(4): 375 - 379. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.E. Tepper, M. O'Connell, D. Hollis, D. Niedzwiecki, E. Cooke, and R.J. Mayer Analysis of Surgical Salvage After Failure of Primary Therapy in Rectal Cancer: Results From Intergroup Study 0114 J. Clin. Oncol., October 1, 2003; 21(19): 3623 - 3628. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kattlove and R. J. Winn Ongoing Care of Patients After Primary Treatment for Their Cancer CA Cancer J Clin, May 1, 2003; 53(3): 172 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. C. Earle, E. Grunfeld, D. Coyle, M. C. Cripps, and H. S. Stern Cancer physicians' attitudes toward colorectal cancer follow-up Ann. Onc., March 1, 2003; 14(3): 400 - 405. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Dimick, J. A. Cowan Jr, J. A. Knol, and G. R. Upchurch Jr Hepatic Resection in the United States: Indications, Outcomes, and Hospital Procedural Volumes From a Nationally Representative Database Arch Surg, February 1, 2003; 138(2): 185 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Yokoyama and H. Yamaue Prediction of Distant Metastasis by Using Reverse Transcriptase-Polymerase Chain Reaction for Epithelial and Variant CD44 mRNA in the Peripheral Blood of Patients With Colorectal Cancer Arch Surg, September 1, 2002; 137(9): 1069 - 1073. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. E. Taylor, J. H. Donohue, L. L. Gunderson, H. Nelson, D. M. Nagorney, R. M. Devine, M. G. Haddock, D. R. Larson, J. Rubin, and M. J. O'Connell The Mayo Clinic Experience With Multimodality Treatment of Locally Advanced or Recurrent Colon Cancer Ann. Surg. Oncol., March 1, 2002; 9(2): 177 - 185. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Fletcher, C. D. Johnson, W. R. Krueger, D. A. Ahlquist, H. Nelson, D. Ilstrup, W. S. Harmsen, and K. E. Corcoran Contrast-Enhanced CT Colonography in Recurrent Colorectal Carcinoma: Feasibility of Simultaneous Evaluation for Metastatic Disease, Local Recurrence, and Metachronous Neoplasia in Colorectal Carcinoma Am. J. Roentgenol., February 1, 2002; 178(2): 283 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Libutti, H. R. Alexander Jr, P. Choyke, D. L. Bartlett, S. L. Bacharach, M. Whatley, F. Jousse, W. C. Eckelman, K. Kranda, R. D. Neumann, et al. A Prospective Study of 2-[18F] Fluoro-2-Deoxy-D-Glucose/Positron Emission Tomography Scan, 99mTc-Labeled Arcitumomab (CEA-Scan), and Blind Second-Look Laparotomy for Detecting Colon Cancer Recurrence in Patients With Increasing Carcinoembryonic Antigen Levels Ann. Surg. Oncol., December 1, 2001; 8(10): 779 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Shureiqi, C. D. Cooksley, J. Morris, A. S. Soliman, B. Levin, and S. M. Lippman Effect of Age on Risk of Second Primary Colorectal Cancer J Natl Cancer Inst, August 15, 2001; 93(16): 1264 - 1266. [Full Text] [PDF]
|
|
|
|
|
|
T. Etoh, H. Ueo, H. Inoue, K. Sato, T. Utsunomiya, G. F. Barnard, S. Kitano, and M. Mori Clinical Significance of K-Ras Mutations in Intraoperative Tumor Drainage Blood From Patients With Colorectal Carcinoma Ann. Surg. Oncol., June 1, 2001; 8(5): 407 - 412. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Lambert, T. A. Colacchio, and R. J. Barth Jr Interval Hepatic Resection of Colorectal Metastases Improves Patient Selection Arch Surg, April 1, 2000; 135(4): 473 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kobayashi, M. Kawamura, and T. Ishihara SURGICAL TREATMENT FOR BOTH PULMONARY AND HEPATIC METASTASES FROM COLORECTAL CANCER J. Thorac. Cardiovasc. Surg., December 1, 1999; 118(6): 1090 - 1096. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E. Desch, A. B. Benson III, T. J. Smith, P. J. Flynn, C. Krause, C. L. Loprinzi, B. D. Minsky, N. J. Petrelli, D. G. Pfister, and M. R. Somerfield Recommended Colorectal Cancer Surveillance Guidelines by the American Society of Clinical Oncology J. Clin. Oncol., April 1, 1999; 17(4): 1312 - 1312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. H. Sugarbaker Surgery for Recurrent Colon Cancer Ann Intern Med, February 2, 1999; 130(3): 239 - 239. [Full Text] [PDF]
|
|
|
|
|
|
C. M. Bagley Jr. Surgery for Recurrent Colon Cancer Ann Intern Med, February 2, 1999; 130(3): 239 - 239. [Full Text] [PDF]
|
|
Article
