Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2010 Nov;79(5):355-361. Korean.
    Published online Nov 12, 2010.
    https://doi.org/10.4174/jkss.2010.79.5.355
    Copyright © 2010 The Korean Surgical Society
    Original Article

    Risk Factors of Peritoneal Recurrence after Curative Resection of Colorectal Cancer

    Byung Mo Kang, M.D., Gyu Seog Choi, M.D., Kyoung Hoon Lim, M.D., In Ja Park, M.D. and Soo Han Jun, M.D.
      • Division of Colorectal Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
    • Corresponding author (Email: kyuschoi@mail.knu.ac.kr )
    Received June 30, 2010; Accepted August 19, 2010.

    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.

    Keywords
    Peritoneal recurrence; Risk factors; Colorectal cancer; Intraperitoneal chemotherapy

    Tables

    Table 1
    Clinicopathologic characteristics (n=1,929)

    Table 2
    Univariate analysis for the risk factors of peritoneal recurrence

    Table 3
    Multivariate logistic regression analysis for risk factors of peritoneal recurrence

    References

      1. Brodsky JT, Cohen AM. Peritoneal seeding following potentially curative resection of colonic carcinoma: implications for adjuvant therapy. Dis Colon Rectum 1991;34:723–727.
      1. Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg 2006;243:212–222.
      1. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer 1989;63:364–367.
      1. Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000;88:358–363.
      1. Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 2004;22:3284–3292.
      1. Yan TD, Black D, Savady R, Sugarbaker PH. Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol 2006;24:4011–4019.
      1. Vaillant JC, Nordlinger B, Deuffic S, Arnaud JP, Pelissier E, Favre JP, et al. Adjuvant intraperitoneal 5-fluorouracil in high-risk colon cancer: a multicenter phase III trial. Ann Surg 2000;231:449–456.
      1. Yu W. A review of adjuvant therapy for resected primary gastric cancer with an update on Taegu's phase III trial with intraperitoneal chemotherapy. Eur J Surg Oncol 2006;32:655–660.
      1. Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. Tokyo: Kanehara & Co., Ltd.; 1997.
      1. Hartley JE, Mehigan BJ, MacDonald AW, Lee PW, Monson JR. Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma. Ann Surg 2000;232:181–186.
      1. Obrand DI, Gordon PH. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum 1997;40:15–24.
      1. Galandiuk S, Wieand HS, Moertel CG, Cha SS, Fitzgibbons RJ Jr, Pemberton JH, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1992;174:27–32.
      1. Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg 2006;93:1115–1122.
      1. Malcolm AW, Perencevich NP, Olson RM, Hanley JA, Chaffey JT, Wilson RE. Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum. Surg Gynecol Obstet 1981;152:131–136.
      1. Cass AW, Million RR, Pfaff WW. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–2865.
      1. Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg 2002;89:1545–1550.
      1. Russell AH, Pelton J, Reheis CE, Wisbeck WM, Tong DY, Dawson LE. Adenocarcinoma of the colon: an autopsy study with implications for new therapeutic strategies. Cancer 1985;56:1446–1451.
      1. Gilbert JM, Jeffrey I, Evans M, Kark AE. Sites of recurrent tumour after 'curative' colorectal surgery: implications for adjuvant therapy. Br J Surg 1984;71:203–205.
      1. Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 1998;14:254–261.
      1. Speyer JL. The rationale behind intraperitoneal chemotherapy in gastrointestinal malignancies. Semin Oncol 1985;12:23–28.
      1. de Bree E, Witkamp AJ, Zoetmulder FA. Intraperitoneal chemotherapy for colorectal cancer. J Surg Oncol 2002;79:46–61.
      1. Jacquet P, Sugarbaker PH. Peritoneal-plasma barrier. Cancer Treat Res 1996;82:53–63.
      1. Speyer JL, Sugarbaker PH, Collins JM, Dedrick RL, Klecker RW Jr, Myers CE. Portal levels and hepatic clearance of 5-fluorouracil after intraperitoneal administration in humans. Cancer Res 1981;41:1916–1922.
      1. Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 1980;40:256–260.
      1. Sugarbaker PH. Surgical management of peritoneal carcinosis: diagnosis, prevention and treatment. Langenbecks Arch Chir 1988;373:189–196.
      1. Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003;21:3737–3743.
      1. Graf W, Westlin JE, Pahlman L, Glimelius B. Adjuvant intraperitoneal 5-fluorouracil and intravenous leucovorin after colorectal cancer surgery: a randomized phase II placebo-controlled study. Int J Colorectal Dis 1994;9:35–39.
      1. Noura S, Ohue M, Seki Y, Yano M, Ishikawa O, Kameyama M. Long-term prognostic value of conventional peritoneal lavage cytology in patients undergoing curative colorectal cancer resection. Dis Colon Rectum 2009;52:1312–1320.
      1. Yang SH, Lin JK, Lai CR, Chen CC, Li AF, Liang WY, et al. Risk factors for peritoneal dissemination of colorectal cancer. J Surg Oncol 2004;87:167–173.
    MeSH Terms
    Colonic Neoplasms
    Colorectal Neoplasms
    Female
    Follow-Up Studies
    Humans
    Korea
    Lymph Nodes
    Male
    Multivariate Analysis
    Recurrence
    Risk Factors
    Metrics
    Share
    Tables
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