Richard M. Goldberg, MD; Thomas R. Fleming, PhD; Catherine M. Tangen, DrPH; Charles G. Moertel, MD; John S. Macdonald, MD; Daniel G. Haller, MD; John A. Laurie, MD
Goldberg RM, Fleming TR, Tangen CM, Moertel CG, Macdonald JS, Haller DG, et al. Surgery for Recurrent Colon Cancer: Strategies for Identifying Resectable Recurrence and Success Rates after Resection. Ann Intern Med. 1998;129:27-35. doi: 10.7326/0003-4819-129-1-199807010-00007
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Published: Ann Intern Med. 1998;129(1):27-35.
Follow-up testing after surgery for colon cancer is recommended principally to identify resectable recurrences, but data on the efficacy of, outcomes of, and optimal strategies for this testing are limited.
To determine the relation between follow-up tests and salvage surgery, assess outcomes, and document surgical mortality.
Retrospective cohort study.
A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone.
1247 patients with resected stage II and stage III colon cancer.
The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented.
Recurrence, resectable recurrence, surgical mortality, and survival were studied.
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 patients), pulmonary metastasis (20 patients), local recurrence (24 patients), 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 patients with second primary colorectal cancer; 12 of these patients have survived disease-free.
Second operations for colon cancer that are triggered by follow-up testing or symptoms are common and can result in long-term disease-free survival.
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Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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