The Contribution of Follow-Up Programs in the Reduction of Mortality of Rectal Cancer Recurrences

Komborozos, V; Skrekas, G; Pissiotis, Christos A.

doi:10.1159/000050182

Cited by 15 publications

(6 citation statements)

References 25 publications

(37 reference statements)

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“…On the other hand, Ohlsson et al [30]reported no statistical difference in the survival between patients with or without intensive postoperative follow-up after curative surgery for colorectal carcinoma. Komborozos et al [31]also showed no statistical difference in the survival after treatment of recurrence between patients with or without symptoms. In this study, curative resection rate was 58.7% in patients with asymptomatic local recurrence and 38.2% in patients with symptomatic local recurrences.…”

Section: Discussionmentioning

confidence: 99%

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

et al. 2003

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Background/Aims: Local pelvic recurrence of rectal cancer after radical resection has been associated with morbidity and cancer-related death. This study retrospectively evaluated outcome following curative resection for rectal cancer recurring after surgery on the basis of prognosis, type of procedure and perioperative morbidity. Methods: A total of 85 consecutive patients with local pelvic recurrence of rectal cancer were evaluated. Of these, 43 underwent microscopic curative surgery for local recurrence. Among the 43 patients, 23 underwent surgery alone and 17 received preoperative radiotherapy (40 Gy) (XRT group) in addition to the surgery. Of the 43 patients, 26 were asymptomatic. Results: Curative resection was higher in the recurrences that were associated with implantation, incomplete surgical margin clearance, and intrapelvic lymph node metastasis than in other types of recurrence. With regard to surgical procedure, abdominoperineal resection (APR), with or without sacral resection, was standard following previous sphincter-preserving surgery, while total pelvic exenteration (TPE), with or without sacral resection, was common following previous APR. Local excision was not considered appropriate surgery. There was a high incidence of perioperative morbidity (64%) in patients receiving TPE. Re-recurrence was observed in 18 patients (50%) after curative surgery. After a follow-up of 2 years or more, the local re-recurrence rate was 28%. The overall 5-year survival rate for patients receiving curative resection was 39%, for patients in the XRT group, 51%, and for patients in the surgery-alone group, 24% (p = 0.07). The survival rate in 26 asymptomatic patients was higher than in 17 patients with symptoms, with 5-year survival rates of 62 and 23% (p < 0.05), respectively. The cumulative local control in the preoperative radiotherapy plus en bloc surgery group (XRT group) was significantly better than in the surgery-alone group (p < 0.01), and survival in the XRT group tended to be better than in surgery alone. Conclusions: These results suggest that careful patient selection according to the pattern of recurrence, area of invasion and presence of symptoms is important for successful curative surgery. Aggressive surgery with adjuvant therapy may lead to an improved salvage rate.

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Section: Discussionmentioning

confidence: 99%

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer

et al. 2003

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“…This assumption was based on the fact that the intensive strategy increased the proportion of resectable tumor recurrences in the whole series as well as in some subsets of patients; more importantly, it increased the probability of overall survival in patients with stage II lesions or rectal tumors [7]. In contrast, Komborozos et al could not reveal a difference in neither the rate of R0-resection rate for recurrent disease nor the overall rate of survival after surgical treatment of recurrence [29]. …”

Section: Discussionmentioning

confidence: 99%

Intensified surveillance after surgery for colorectal cancer significantly improves survival

Laubert¹,

Bader²,

Oevermann³

et al. 2010

Eur J Med Res

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Background Postoperative surveillance after curative resection for colorectal cancer has been demostrated to improve survival. It remains unknown however, whether intensified surveillance provides a significant benefit regarding outcome and survival. This study was aimed at comparing different surveillance strategies regarding their effect on long-term outcome. Methods Between 1990 and 2006, all curative resections for colorectal cancer were selected from our prospective colorectal cancer database. All patients were offered to follow our institution's surveillance programm according to the ASCO guidelines. We defined surveillance as "intensive" in cases where > 70% appointments were attended and the program was completed. As "minimal" we defined surveillance with < 70% of the appointments attended and an incomplete program. As "none" we defined the group which did not take part in any surveillance. Results Out of 1469 patients 858 patients underwent "intensive", 297 "minimal" and 314 "none" surveillance. The three groups were well balanced regarding biographical data and tumor characteristics. The 5-year survival rates were 79% (intensive), 76% (minimal) and 54% (none) (OR 1.480, (95% CI 1.135-1.929); p < 0.0001), respectively. The 10-year survival rates were 65% (intensive), 50% (minimal) and 31% (none) ( p < 0.0001), respectively. With a median follow-up of 70 months the median time of survival was 191 months (intensive), 116 months (minimal) and 66 months (none) ( p < 0.0001). After recurrence, the 5-year survival rates were 32% (intensive, p = 0.034), 13% (minimal, p = 0.001) and 19% (none, p = 0.614). The median time of survival after recurrence was 31 months (intensive, p < 0.0001), 21 months (minimal, p < 0.0001) and 16 month (none, p < 0.0001) respectively. Conclusion Intensive surveillance after curative resection of colorectal cancer improves survival. In cases of recurrent disease, intensive surveillance has a positive impact on patients' prognosis. Large randomized, multicenter trials are needed to substantiate these results.

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“…A large number of studies concerning follow-up after resection for colorectal cancer have been published, but most of them are non-randomized single cohort studies, and only a few are prospective randomized studies (7,16,18,25,26,94) or comparative cohort studies (11,15,17,24,91,93) (Table 3). The control groups in all the cohort studies are patients that partly or totally have refused to participate in the follow-up programme.…”

Section: Follow-up Studiesmentioning

confidence: 99%