VALUE OF CARCINOEMBRYONIC ANTIGEN MONITORING IN CURATIVE SURGERY FOR RECURRENT COLORECTAL-CARCINOMA

PURPOSE: This study is designed to review a carcinoembryonic antigen ( CEA)-driven postoperative protocol designed to identify patients suita ble for curative reresection when recurrent colorectal cancer is ident ified. METHODS: A total of 285 patients who were operated on for colon or rectal carcinoma between 1981 and 1985 were evaluated (with CEA le vels) every two months for the first two years, every three months for the third year, every six months for years 4 and 5, and annually ther eafter. CEA levels above 5 mu g were considered abnormal and were eval uated with diagnostic imaging and/or endoscopy. RESULTS: Follow-up was available for 280 patients (98.2 percent). Distribution of patients b y Astler-Coller was: A, 14 percent; B-1, 20 percent; B-2, 39 percent; C-1, 5 percent; C-2, 21 percent. There were 62 of 280 patients (22 per cent) who developed elevated CEA levels, with 44 patients who demonstr ated clinical or radiographic evidence of recurrence. Eleven patients were selected for surgery with curative intent (4 hepatic resections, 1 pulmonary wedge resection, 2 abdominoperineal resections, 2 segmenta l bowel resections, and 2 cranial metastasectomies). Three of 11 patie nts (27 percent) benefited and have disease-free survivals greater tha n 60 months. Of the 223 patients without elevated CEA, 22 (9.9 percent ) had recurrent cancer without any survivors. Overall, 3 of 285 patien ts (1.1 percent) were cured as a result of CEA follow-up. CONCLUSION: CEA-driven surgery is useful in selected patients and can produce long -term survivors.