J Korean Surg Soc.  2010 Nov;79(5):355-361. 10.4174/jkss.2010.79.5.355.

Risk Factors of Peritoneal Recurrence after Curative Resection of Colorectal Cancer

• Kang BM
• Choi GS
• Lim KH
• Park IJ
• Jun SH

• KMID: 2212041
• DOI: http://doi.org/10.4174/jkss.2010.79.5.355

Abstract

PURPOSE
Peritoneal recurrence after curative resection of colorectal cancer has been considered to be a lethal condition and to be suitable for palliative chemotherapy. Recently, aggressive approaches such as cytoreductive surgery and perioperative intraperitoneal chemotherapy were introduced for peritoneal malignancies to improve survival. The aim of this study is to identify the risk factors of peritoneal recurrence after curative resection of colorectal cancer and to determine the indication of early postoperative intraperitoneal chemotherapy (EPIC).
METHODS
From January 1997 to December 2007, a total of 2,320 patients' records with curative resection for colorectal cancer were collected through the prospective colorectal cancer registry protocol in Kyungpook National University Hospital, Korea. Of those, a total of 1,929 patients were included for analysis of the relationship between perioperative clinicopathologic variables and peritoneal recurrence.
RESULTS
The study group was composed of 1,086 men and 843 women with a mean age of 61.1. In multivariate analysis, preoperative level of serum CA19-9>37 U/ml (odd ratio [OR] 3.217; 95% confidence interval [95% CI] 1.525~6.788), right colon cancer (OR 2.524; 95% CI 1.158~5.502), pT4 tumor (OR 2.131; 95% CI 1.009~4.502) and positive apical lymph node (OR 3.045; 95% CI 1.023~9.066) were independent risk factors of peritoneal recurrence after curative resection of colorectal cancer.
CONCLUSION
In colorectal cancer patients with increased preoperative serum levels of CA19-9, right-sided location, serosal exposure or invasion of adjacent organ, and positive apical lymph node, more scrupulous surveillance for peritoneal recurrence was necessary during the postoperative follow-up period. In selective patients with risk factors of peritoneal recurrence, more aggressive strategies for management, such as EPIC, were able to be considered under the acceptable general condition and life-expectancy.

Keyword

Peritoneal recurrence; Risk factors; Colorectal cancer; Intraperitoneal chemotherapy

MeSH Terms

Colonic Neoplasms
Colorectal Neoplasms
Female
Follow-Up Studies
Humans
Korea
Lymph Nodes
Male
Multivariate Analysis
Recurrence
Risk Factors

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