title: Second-look operation for recurrent colorectal cancer based on carcinoembryonic antigen and imaging techniques.
abstract: OBJECTIVE
  The usefulness of postoperative carcinoembryonic antigen (CEA) monitoring and improvements in imaging techniques have renewed enthusiasm for second-look operations (SLO) as the most effective treatment for recurrent colorectal cancer by reresection following early detection. The aim of our study is to evaluate the role of CEA and imaging techniques-directed SLO.
  
  
  METHODS
  Seven hundred fifty-six patients with Dukes Stages B and C, who had undergone curative resection, were monitored postoperatively using CEA and imaging techniques. An SLO was performed on any potentially resectable recurrence, and in addition, an SLO was done when a persistently rising CEA value was detected.
  
  
  RESULTS
  Recurrence developed in 18.8 percent (142/756) of patients, and 90.8 percent (129/142) of the recurrences were detected within the first three years following curative resection. When comparing carcinomas of the colon with that of the rectum, the former were associated with significantly more hepatic and intraabdominal recurrences, whereas the latter had significantly more locoregional and pulmonary recurrences. Seventy-two patients underwent SLO. Of these patients, 54.2 percent (39/72) had all of their disease resected, and 1.4 percent (1/72) had no detectable disease at the SLO. Among the 142 patients with recurrence, 71 (50 percent) patients underwent SLO. The resectable group at SLO carried a significantly better survival than the unresectable recurrence group (41.3 vs. 5.2 percent; P<0.01).
  
  
  CONCLUSIONS
  Complete removal of colorectal cancer recurrences by SLO, on the basis of postoperative, follow-up CEA and imaging technique findings, results in improved survival.
authors.affiliation: First Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Hida
authors.forename: M
authors.initials: M
authors.lastname: Yasutomi
authors.forename: K
authors.initials: K
authors.lastname: Shindoh
authors.forename: M
authors.initials: M
authors.lastname: Kitaoka
authors.forename: K
authors.initials: K
authors.lastname: Fujimoto
authors.forename: S
authors.initials: S
authors.lastname: Ieda
authors.forename: N
authors.initials: N
authors.lastname: Machidera
authors.forename: R
authors.initials: R
authors.lastname: Kubo
authors.forename: E
authors.initials: E
authors.lastname: Morikawa
authors.forename: H
authors.initials: H
authors.lastname: Inufusa
authors.forename: M
authors.initials: M
authors.lastname: Watatani
authors.forename: K
authors.initials: K
authors.lastname: Okuno
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D011182:Postoperative Care; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D002272:Carcinoembryonic Antigen