INCIDENCE AND PATTERNS OF RECURRENCE FOLLOWING CURATIVE RESECTION FORCOLORECTAL-CARCINOMA

PURPOSE: This study was designed to determine incidence and patterns o f recurrence after curative resection of colorectal carcinoma and to d etermine which variables are significant in predicting outcome. METHOD : A retrospective review of 524 patients operated on by one surgeon fr om 1975 to 1992 was conducted. Variables recorded included age, gender , location, gross morphology, histology, stage of each primary and evi dence of perforation and direct extension at time of original operatio n. Overall survival and pattern of recurrence were documented. RESULTS : Overall recurrence rate was 27.9 percent. Anastomotic recurrence rat e was 11.7 percent. Anastomotic recurrences were higher for rectal tha n colon lesions (20.3 vs. 6.2 percent; P = 0.001). Distant metastases developed in 14.4 percent of patients, 13.9 percent for colon carcinom a and 15.5 percent for rectal carcinoma. Average time for anastomotic recurrence was 16.2 months vs. 22.9 months for distant disease. T1,2,N 0,M0 lesions had a 17.6 percent recurrence rate, T3,N0,M0 was 23.4 per cent, and T1,2,3,N1,M0 was 43.7 percent (P = .001). Patients who did n ot undergo any intervention after diagnosis of recurrence survived an average of 28 months. Those who received palliative treatment survived an average of 39 months. Twenty-four percent of patients had reresect ion for cure, and 47 percent of these patients were alive at a mean of 80 months; those who died of their disease did so at an average of 53 months. Positive predictive factors for recurrence include site of le sion (rectum vs. colon), stage, invasion of contiguous organs, and pre sence of perforation. Age, gender, degree of differentiation, mucin se cretion, and gross morphology were not found to be predictive factors in this study. CONCLUSIONS: Recurrence after resection for rectal carc inoma is higher than after colon carcinoma. In those patients in whom reresection is possible, up to 50 percent may have longterm survival. Understanding patterns of recurrence and features that predispose to t hem may guide the physician in aggressive but more selective adjuvant therapy and recommendations for targeted surveillance in follow-up.