SURGERY FOR RECURRENT COLON-CANCER - STRATEGIES FOR IDENTIFYING RESECTABLE RECURRENCE AND SUCCESS RATES AFTER RESECTION

Background: Follow-up testing after surgery for colon cancer is recomm ended principally to identify resectable recurrences, but data on the efficacy of, outcomes of, and optimal strategies for this testing are limited. Objectives: To determine the relation between followup tests and salvage surgery, assess outcomes, and document surgical mortality. Design: Retrospective cohort study. Setting: A North American multi-i nstitutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone. Patients: 1247 patients with resected stage II and stage III colon cancer. Intervention: The protocol mandated follow -up testing that could be supplemented at the discretion of treating p hysicians. Indications of recurrent disease were documented. Measureme nts: Recurrence, resectable recurrence, surgical mortality, and surviv al were studied. Results: 548 patients had recurrence of colon cancer. Salvage surgery was attempted in 222 patients (41%). In 109 patients (20%), curative-intent surgery was done for hepatic recurrence (28 pat ients), pulmonary metastasis (20 patients), local recurrence (24 patie nts), or recurrence at other sites (37 patients). Most curative-intent surgical procedures were motivated by follow-up testing (36 patients) , elevated carcinoembryonic antigen level (41 patients), or symptoms ( 27 patients). The median follow-up time after curative-intent surgery exceeded 5 years; the estimated 5-year disease-free survival rate was 23%. A solitary lesion was a favorable prognostic factor. The surgical mortality rate was 2%. Curative-intent resections were done in 15 pat ients with second primary colorectal cancer; 12 of these patients have survived disease-free. Conclusions: Second operations for colon cance r that are triggered by follow-up testing or symptoms are common and c an result in long-term disease-free survival.