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Surgery for Recurrent Colon Cancer: Strategies for Identifying Resectable Recurrence and Success Rates after Resection

Richard M. Goldberg, MD; Thomas R. Fleming, PhD; Catherine M. Tangen, DrPH; Charles G. Moertel, MD; John S. Macdonald, MD; Daniel G. Haller, MD; and John A. Laurie, MD
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For the Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. From the Mayo Clinic, Rochester, Minnesota; the Fred Hutchinson Cancer Research Center, Seattle, Washington; Temple University School of Medicine and the University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania; and Grand Forks Clinic, Grand Forks, North Dakota. (Moertel) Deceased. Acknowledgments: The authors thank John Van-Damme, BS, BA, from the Southwest Oncology Group; Deborah Papenfus from the North Central Cancer Treatment Group; the investigative teams from the North Central Treatment Group, the Southwest Oncology Group, and the Eastern Cooperative Oncology Group; and the patients who participated in the trial. Grant Support: In part by grants CA-25224, CA-31224, and CA-37404 to the North Central Cancer Treatment Group; grants CA-32102, CA-37429, and CA-39091 to the Southwest Oncology Group; grants CA-21115, CA-37403, and CA-39088 to the Eastern Cooperative Oncology Group; and grants to individual participating institutions from the National Cancer Institute, National Institutes of Health, and Department of Health and Human Services. Requests for Reprints: Richard M. Goldberg, MD, Division of Medical Oncology, Mayo Clinic E12, 200 First Street SW, Rochester, MN 55905; e-mail, goldberg.richard@mayo.edu. Current Author Addresses: Dr. Goldberg: Division of Medical Oncology, Mayo Clinic E12, 200 First Street SW, Rochester, MN 55905.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(1):27-35. doi:10.7326/0003-4819-129-1-199807010-00007
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Background: 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.

Objectives: To determine the relation between follow-up tests and salvage surgery, assess outcomes, and document surgical mortality.

Design: Retrospective cohort study.

Setting: A North American multi-institutional 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 physicians. Indications of recurrent disease were documented.

Measurements: Recurrence, resectable recurrence, surgical mortality, and survival 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 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.

Conclusions: 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.

Figures

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Figure 1.
Disease-free survival after curative-intent salvage surgery by site of relapse.
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Figure 2.
Disease-free survival after curative-intent salvage surgery by relapse interval.
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Figure 3.
Disease-free survival after curative-intent salvage surgery by number of lesions.
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