Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum

• Published in: Cancer 1980-06, Vol.45 (12), p.2969-2974
• Main Authors: Olson, R. M., Perencevich, N. P., Malcolm, A. W., Chaffey, J. T., Wilson, R. E.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - surgery; Colonic Neoplasms - surgery; Female; Follow-Up Studies; Humans; Male; Methods; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prognosis; Rectal Neoplasms - surgery
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19800615)45:12<2969::AID-CNCR2820451214>3.0.CO;2-7

This study explores the patterns of recurrence after “curative” operation for colorectal cancer. For an 11‐year period, 1960–1971, 281 evaiuable patients were resected at the Peter Bent Brigham Hospital. Crude five‐year survival in these patients was 49%, but only 10% of those with recurrence lived five years. A total of 69 patients relapsed during their lifetime and 34 additional patients were found to have metastases at death. The initial site of metastases was regional in 23 patients (33%) and distant in 32 (46%). Simultaneous regional and distant metastases were found in 13 (19%) for a total of 65% of patients having initial distant metastases. Approximate recurrence rates by site were: 30% for sigmoid and rectum, 20% for right colon, and 10% for transverse and left colon. Tumor size was a significant determinant of recurrence but did not select for regional or distant sites. Recurrence by Astler‐Coller modification of the Dukes‐Kirklin classification revealed 10% for A + B1, 33% for B2, 35% for C1, and 50% for C2. More than half of the patients with distant metastases (18/32) had solely hepatic metastases yet the total incidence of liver metastases as the initial site was only 8% of the total. In general, the site of the primary cancer was the most important determinant of the type of recurrence; the stage and site of the primary tumor were most predictive for eventual relapse.