Surgery for recurrent colon cancer: Strategies for identifying resectable recurrence and success rates after resection

Background: Follow-up testing after surgery for colon cancer is recommended principally to identify resectable recurrences, but data on the efficacy of, outcomes of, and optimal strategies for this testing are limited. Objectives: To determine the relation between followup tests and salvage surgery, assess outcomes, and document surgical mortality. Design: Retrospective cohort study. Setting: A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone. Patients: 1247 patients with resected stage II and stage III colon cancer. Intervention: The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented. Measurements: Recurrence, resectable recurrence, surgical mortality, and survival were studied. Results: 548 patients had recurrence of colon cancer. Salvage surgery was attempted in 222 patients (41%). In 109 patients (20%), curative-intent surgery was done for hepatic recurrence (28 patients), pulmonary metastasis (20 patients), local recurrence (24 patients), or recurrence at other sites (37 patients). Most curative-intent surgical procedures were motivated by follow-up testing (36 patients), elevated carcinoembryonic antigen level (41 patients), or symptoms (27 patients). The median follow-up time after curative-intent surgery exceeded 5 years; the estimated 5-year disease-free survival rate was 23%. A solitary lesion was a favorable prognostic factor. The surgical mortality rate was 2%. Curative-intent resections were done in 15 patients with second primary colorectal cancer; 12 of these patients have survived disease-free. Conclusions: Second operations for colon cancer that are triggered by follow-up testing or symptoms are common and can result in long-term disease-free survival.