Abdominal wall recurrence after colorectal resection for cancer

PURPOSE: Disease recurrence in the abdominal wall from a primary colorectal cancer is a poorly studied and little understood phenomenon that has recei ved renewed attention after the recognition of port site metastases in pati ents after laparoscopic colorectal resections. The purpose of the present s tudy was to define the clinical, pathologic, and management issues in patie nts with abdominal mall metastases from colorectal cancer. METHODS: Patient s presenting to Memorial Sloan-Kettering Cancer Center with a diagnosis of colorectal cancer were entered into a prospective database beginning in 198 6. Review of this database showed that 31 patients presenting with recurren t disease in the abdominal wall were managed surgically at the institution between 1986 and 1998. RESULTS: A total of 31 patients (19 males) with a me dian age of 67 (range, 45-86) years presented with recurrent disease betwee n 7 and 185 (median, 24) months after primary surgery. Primary tumors were located in the right colon in 17 patients, left colon in 2 patients, sigmoi d colon in 7 patients, and rectum in 3 patients. Nineteen percent of primar y tumors were perforated, 45 percent were poorly differentiated, 92 percent were transmural (T3 or T4), and 51 percent had lymph node metastases at pr esentation. Twenty-two patients presented with a symptomatic abdominal wall mass, whereas recurrence in the abdominal wall was found incidentally in 3 patients undergoing laparotomy. Four patients had isolated abdominal wall disease, whereas the remaining 27 were found to have associated intra-abdom inal disease. Six patients who were left with residual intra-abdominal canc er after abdominal wall resection had a median survival time of four months . Twenty-five patients underwent a histologically: complete resection of re currence restricted to the abdominal wall alone (n = 4; median survival tim e, 18 months), abdominal mall and in continuity resection of adherent visce ra (n = 15; median survival time, 12.5 months), or resection of abdominal w all and intra-abdominal recurrence at a distant site (n = 6; median surviva l time, 22 months, although only 1 patient remained alive with disease). Th e actual two-year and five-year disease-free survival rates were 16 and 3 p ercent, respectively. CONCLUSION: Abdominal wall metastases are often indic ators of recurrent intra-abdominal cancer; however, aggressive resection in patients with disease restricted to the abdominal wall and associated adhe rent viscera can result in local disease control with Little morbidity and no mortality.