2ND-LOOK OPERATION FOR RECURRENT COLORECTAL-CANCER BASED ON CARCINOEMBRYONIC ANTIGEN AND IMAGING TECHNIQUES

PURPOSE: The usefulness of postoperative carcinoembryonic antigen (CEA ) monitoring and improvements in imaging techniques have renewed enthu siasm for second-look operations (SLO) as the most effective treatment , for recurrent colorectal cancer by reresection following early detec tion. The aim of our study is to evaluate the role of CEA and imaging techniques-directed SLO. METHODS: Seven hundred fifty-six patients wit h Dukes Stages B and C, who had undergone curative resection, were mon itored postoperatively using CEA and imaging techniques. An SLO was pe rformed on any potentially resectable recurrence, and in addition, an SLO was done when a persistently rising CEA. value was detected. RESUL TS: Recurrence developed in 18.8 percent (142/756) of patients, and 90 .8 percent (129/ 142) of the recurrences mere detected within the firs t three years following curative resection. When comparing carcinomas of the colon with that of the rectum, the former were associated with significantly more hepatic and intraabdominal recurrences, whereas the latter had significantly more locoregional and pulmonary recurrences. Seventy-two patients underwent SLO. Of these patients, 54.2 percent ( 39/72) had all of their disease resected, and 1.4 percent (1/72) had n o detectable disease at the SLO. Among the 142 patients with recurrenc e, 71 (50 percent) patients underwent SLO. The resectable group at SLO carried a significantly better survival than the unresectable recurre nce group (41.3 vs. 5.2 percent; P < 0.01). CONCLUSIONS: Complete remo val of colorectal cancer recurrences by SLO, on the basis of postopera tive, follow-up CEA and imaging technique findings, results in improve d survival.