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J Korean Soc Coloproctol. 1999 Dec;15(5):386-396. Korean. Original Article.
Kim SH , Kim HR , Kim DY , Kim YJ .
Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Kwangju, Korea.
Abstract

PURPOSE: Recurrent disease after curative surgery for primary colorectal cancer is well-known problem. Recurred colorectal cancer, even hepatic metastasis, can be operable in case of non-systemic metastasis. In those cases, a favorable prognosis is expected. But, regrettably in most cases which showed recurrence after curative surgery poor prognosis was remained. METHODS: In our hospital, we have experienced 98 patients with recurred colorectal cancer among 607 patients who had curative operation from Jan. 1980 to Feb. 1998. We analyzed retrospectively those patients and considered factors which influenced recurrence of disease and prognosis (type of recurrence, age, sex, location of tumor, histology of tumor, size of tumor, depth of tumor invasion, lymph node involvement, tumor stage, DNA ploidy pattern, serum CEA level, oncogene expression of tumor and reoperation). RESULTS: 1) The Mean of disease-free interval after curative operation was 15.9 months (range: 3.0~44.5 months). 2) Among total patients with recurrence, patients with local recurrence were 29 cases (29.6%), those with liver metastasis were 29 cases (29.6%), lung metastasis were 7 cases (7.1%), lung and liver metastasis were 7 cases (7.1%), peritoneal metastasis were 18 cases (18.4%), lymph node metastasis were 7 cases (7.1%), brain metastasis was 1 case (1.0%). 3) The curative reoperation was performed in 19 patients (19.4%). Those procedures were abdominoperineal resection (4), local perineal resection (6), hepatic resection (2), Hartmann's procedure (2), segmental resection of ileum (2), Whipple's operation (1), resection of ileal pouch in patient with FAP (1), oophorectomy (1). 4) Those factors which influenced recurrence were tumor stage, histologic type of tumor, depth of tumor invasion, lymph node status, preoperative serum CEA level. 5) The mean survival time of patients with recurred colorectal cancer was 25.1 months. The 36 months survival rate of patients with recurred colorectal cancer among various sites of recurrence was different significantly (p=0.04). Those patients with local recurrence showed most favorable prognosis (42.0% in 36 months survival rate) and those with liver metastasis showed worst prognosis (4.7%). 6) The 36 months survival rate of reoperative group was 54.3% and that of non-operative group was 20.5 months. The result of two groups was statistically different (p<0.001). CONCLUSIONS: We concluded that those factors which influenced recurrence in colorectal cancer were tumor stage, histologic type, invasion depth, lymph node status, and preoperative serum CEA level. Also the survival rate of reoperative group was higher than that of non-operative group statistically.

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