Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group.
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.


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


METHODS
Retrospective cohort study.


METHODS
A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone.


METHODS
1247 patients with resected stage II and stage III colon cancer.


METHODS
The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented.


METHODS
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.
Goldberg
R M
RM
Mayo Clinic, Rochester, Minnesota 55905, USA. goldberg.richard@mayo.edu
Fleming
T R
TR
Tangen
C M
CM
Moertel
C G
CG
Macdonald
J S
JS
Haller
D G
DG
Laurie
J A
JA
D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome