WOUND RECURRENCE FOLLOWING CONVENTIONAL TREATMENT OF COLORECTAL-CANCER - A RARE BUT PERHAPS UNDERESTIMATED PROBLEM

Reports of trocar and extraction site tumor recurrences following lapa roscopic colectomy raise concern that such recurrences may be occurrin g more frequently with laparoscopic compared with open colectomy. Cont emporary data on the incidence of incisional recurrence following open colectomy, in the age of adjuvant therapies, are not available. PURPO SE: This study was undertaken to examine the incidence and clinical fe atures of wound recurrence in current prospective trials including 1,7 11 patients with primary adenocarcinoma of the colon or rectum treated for cure. METHODS: Files of all patients with recurrence (n = 623) we re reviewed. Each site of recurrence was recorded separately. All pati ents have been followed prospectively and 3-year and 4-year data are m ature on 100 and 70 percent, respectively. Stage at diagnosis was B2 i n 344 patients and C in 1,367 patients (>4 nodes positive in 346 patie nts). RESULTS: Recurrence was identified in 623 patients (36.4 percent ) and occurred at a mean of 1.5 years following primary treatment. Ele ven patients (0.6 percent) had documented incisional recurrences (9 ab dominal wound, 1 perineal wound, and 1 stoma wound). Only four were di agnosed clinically, and the remaining seven were diagnosed incidentall y at reoperation. Of 11 patients with incisional wound recurrences, 2 had primary Stage B2 and 9 had primary Stage C disease. Nine of 11 pat ients were found to have multiple sites of recurrence at time of recur rence. At a mean follow-up of 1.8 years after recurrence, 3 of 11 pati ents are alive with disease, although 8 have died because of disease. CONCLUSIONS: Incisional recurrence is uncommon, although likely undere stimated, following conventional treatment of colorectal carcinoma. It s occurrence is usually a harbinger of diffuse intra-abdominal disease . These data may provide useful information for investigations of lapa roscopic approaches to colon cancer.