T. Chesney1, A. Nadler2, S. A. Acuna3,4, C. J. Swallow1,5 1University Of Toronto,Division Of General Surgery, Department Of Surgery,Toronto, ON, Canada 2Fox Chase Cancer Center,Department Of Surgical Oncology,Philadelphia, PA, USA 3University Of Toronto,Institute Of Health Policy, Management And Education,Toronto, ON, Canada 4St. Michael’s Hospital,Li Ka Shing Knowledge Institute And Department Of Surgery,Toronto, ON, Canada 5Mount Sinai Hospital,Division Of General Surgery, Department Of Surgery,Toronto, ON, Canada
Background: The role of resection for locoregionally recurrent colon cancer (LRCC) is unclear. Given that surveillance efforts aim to detect recurrence early to allow further intervention, we systematically reviewed all published evidence for the outcomes of resection of LRCC.
Methods: a systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies that reported overall survival following resection of LRCC and included 10 or more patients. We present the pooled re-recurrence, and 3-year and 5-year overall survival (OS) rates along with a narrative synthesis of primary tumour and LRCC characteristics, treatment of LRCC and its associated morbidity.
Results: Nine case series were identified reporting outcomes of 543 patients; one of which was population-based. Although a significant proportion of patients (42.2%) who underwent resection experienced morbidity, the 30-day post-operative mortality was low (2.6%). An R0 resection was achieved in half of the patients (48.3%) who underwent surgical resection with good survival rates (3-year OS 57.6%, 95% CI: 39.2–76.0; 5-year OS 52.1%, 95% CI: 32.2-72.0). Patients with microscopic residual disease (R1) had poorer survival (3-year OS 26.8%, 95% CI: 12.3–41.2; 5-year OS 11.4%, 95% CI: 2.0-24.7). Macroscopic residual disease (R2) had no 5-year survivors. The pooled re-recurrence rate was 25.1% overall.
Conclusion: The literature for resection of LRCC is limited to case series. The summarized studies suggest LRCC resection can be performed safely and half of patients in whom a complete resection is achieved survive for 5 years or more. These outcomes in highly selected patients exceed those normally associated with LRCC. However, the evidence available does not allow us to ascertain whether this is the result of the surgical resection or patient selection.