title: Anastomotic recurrence of colon cancer: Genetic analysis challenges the widely held theories of cancerous cells' intraluminal implantation and metachronous carcinogenesis.
abstract: OBJECTIVE
  Anastomotic recurrence (AR), whose etiopathogenesis is attributed to intraluminal implantation of cancerous cells or metachronous carcinogenesis, is a major issue for patients undergoing colon cancer (CC) resection. The objective of the study is to throw some light on AR etiopathogenesis and to identify risk factors of AR in selecting patients to undergo early endoscopy.
  
  
  METHODS
  An analysis of clinical and histopathological parameters, including MSI and LOH of seven sites (Myc-L, BAT26, BAT40, D5S346, D18S452, D18S64, D16S402) was performed in primary CC and AR of 18 patients. They were then compared to 36 controls not developing AR.
  
  
  RESULTS
  A genetic instability was present in 16/18 patients, with distinct genetic patterns between primaries and ARs. LOH at 5q21 and/or 18p11.23 were found in both primary and AR in >50% of cases, but this rate was no different from control population. CEA resulted as associated with AR (P = 0.03), whereas N status presented a borderline result (P = 0.08).
  
  
  CONCLUSIONS
  Our findings challenge present theories about AR development. No "genetic marker" has been found. CEA and, to a lesser extent, N status, appear associated with AR. Rectal washout is seemingly meaningless. Iterative resection should be recommended since a long survival may be expected. J. Surg. Oncol. 2016;114:228-236. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Caterina
authors.initials: C
authors.lastname: Santi
authors.affiliation: Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Lorena
authors.initials: L
authors.lastname: Bottarelli
authors.affiliation: Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Azzoni
authors.affiliation: Service de Chirurgie Digestive, Hôpital "Simone Veil", Eaubonne, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Zarzavadjian Le Bian
authors.affiliation: Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Matteo
authors.initials: M
authors.lastname: Riccó
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Sarli
authors.affiliation: Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Silini
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Violi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000235:genetics / Q000473:pathology*; D005260:Female; D042822:Genomic Instability; D006801:Humans; D019656:Loss of Heterozygosity; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000473:pathology
keywords: CEA; allelic loss; anastomotic recurrence; colorectal cancer; genetic alterations