Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial.
OBJECTIVE
Intensive postoperative surveillance is associated with improved survival and recommended for patients with late stage (stage IIB and III) colon cancer. We hypothesized that stage I and IIA colon cancer patients would experience similar benefits.


METHODS
Secondary analysis of data from the Clinical Outcomes of Surgical Therapy trial was performed by analyzing results according to TNM stage; early (stage I and IIA, 537 patients) and late (stage IIB and III, 254 patients) stage disease. Five-year recurrence rates were higher in patients with late (35.7%) versus early stage disease (9.5%). Early and late stage salvage rates, recurrence patterns and methods of first detection were compared by chi(2) test.


RESULTS
Salvage rates for early- and late-stage disease patients with recurrence were the same (35.9% v 37%; P = .9, respectively). Median survival after second surgery after recurrence was 51.2 and 35.8 months for early- and late-stage patients, respectively. Single sites of first recurrence did not significantly differ between early and late stage, but multiple sites of recurrence occurred less often in early-stage patients (3.6% v 28.6%, for early v late, respectively; P < .001). METHODS of first detection of recurrence were not significantly different: carcinoembryonic antigen (29.1% v 37.4%), computed tomography scan (23.6% v 26.4%), chest x-ray (7.3% v 12.1%), and colonoscopy (12.7% v 8.8%), for early versus late stage disease, respectively.


CONCLUSIONS
Patients with early-stage colon cancer have similar sites of recurrence, and receive similar benefit from postrecurrence therapy as late-stage patients; implementation of surveillance guidelines for early-stage patients is appropriate.
Tsikitis
Vassiliki L
VL
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Malireddy
Kishore
K
Green
Erin A
EA
Christensen
Brent
B
Whelan
Richard
R
Hyder
Jace
J
Marcello
Peter
P
Larach
Sergio
S
Lauter
David
D
Sargent
Daniel J
DJ
Nelson
Heidi
H
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000592:standards; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D011182:Postoperative Care; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome