SURVEILLANCE OF COLORECTAL-CANCER - EFFECTIVENESS OF EARLY DETECTION OF INTRALUMINAL RECURRENCES ON PROGNOSIS AND SURVIVAL OF PATIENTS TREATED FOR CURE

PURPOSE: The authors evaluate the effectiveness of routine colonoscopy and marker evaluation in diagnosis of intraluminal recurrent cancer. METHODS: Chart review was conducted on 481 patients who underwent cura tive resection for colorectal cancer between 1980 and 1990. Clinical v isits were scheduled and carcinoembryonic antigen evaluation was perfo rmed every three months, and colonoscopy was performed preoperatively, 12 to 15 months after surgical treatment, and then with intervals of 12 to 24 months or when symptoms appeared. RESULTS: About 10 percent o f patients developed intraluminal recurrences. More than one-half of m etachronous lesions arose within the first 24 months, and median time to diagnosis was 25 months. Patients with left-sited tumors in the adv anced stage had a higher risk of developing recurrent intraluminal dis ease. Twenty-nine patients underwent a second surgical operation, of w hich 17 cases were radical. In this group, the five-year survival was 70.6 percent, although no nonradically treated or nonresected patients survived longer than 31 months. Twenty-two patients were asymptomatic at time of diagnosis of recurrence, and of these, 12 patients underwe nt radical operation; on the other hand, of the 24 symptomatic patient s, only 5 were treated radically. Carcinoembryonic antigen was the fir st sign of recurrence in eight cases. Colonoscopy must be performed wi thin the first 12 to 15 months after operation, whereas an interval of 24 months between examinations seems sufficient to guarantee early de tection of metachronous lesions. CONCLUSION: Serial tumor marker evalu ation is of help in earlier diagnosis of local recurrences. Asymptomat ic patients more frequently undergo another operation for cure and thu s have a better survival rate.