Surgery for recurrent colon cancer: Strategies for identifying resectable recurrence and success rates after resection
Surgery for recurrent colon cancer: Strategies for identifying resectable recurrence and success rates after resection
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DOI：
10.7326/0003-4819-129-1-199807010-00007
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发表时间：
1998-07-01
影响因子：
39.2
通讯作者：
Laurie, JA
中科院分区：
文献类型：
--
作者：
Goldberg, RM;Fleming, TR;Laurie, JA
背景：结肠癌手术后的随访检查主要被推荐用于确定可切除的复发，但关于该检查的疗效、结果和最佳策略的数据有限。目的：确定随访检查与挽救性手术之间的关系，评估结果，并记录手术死亡率。设计：回顾性队列研究。背景：一项北美多机构试验，比较术后化疗加随访与单独随访。患者：1247例II期和III期结肠癌切除患者。干预：该方案规定了后续检测，可由治疗医生酌情补充。疾病复发的指征被记录下来。测量：研究复发、可切除复发、手术死亡率和生存率。结果：548例患者有结肠癌复发。222例（41%）患者尝试了挽救性手术。在109例（20%）患者中，因肝脏复发（28例）、肺转移（20例）、局部复发（24例）或其他部位复发（37例）而进行了治疗目的手术。大多数以治疗为目的的手术是由随访检测（36例）、癌胚抗原水平升高（41例）或症状（27例）引起的。治疗目的手术后中位随访时间超过5年；估计5年无病生存率为23%。单发病变是一个有利的预后因素。手术死亡率为2%。15例第二原发结直肠癌患者进行了治疗目的切除；其中12名患者无病存活。结论：由随访检查或症状引发的结肠癌二次手术是常见的，并可导致长期无病生存。
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.Objectives: To determine the relation between followup tests and salvage surgery, assess outcomes, and document surgical mortality.Design: Retrospective cohort study.Setting: A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone.Patients: 1247 patients with resected stage II and stage III colon cancer.Intervention: The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented.Measurements: 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.