Purpose: To identify clinical predictors of recurrence of colorectal cancer after curative surgical treatment. Methods: Retrospective follow-up-study of 925 consecutive patients treated with R0-resection for colorectal cancer Stage I, II and III from 1990 until 2000 with a mean follow-up of 60 ± 37 months. Predictors for cancer recurrence were identified in a pilot-sample of these patients, followed by analyses of the rest of the patients (test-sample), and finally with a concluding analyses of the entire patient group. Data were analyzed with Pearson Chi-square test ( χ 2 ), Cox regression analyses and log rank test. Results: Tumor stage (Stage I: HR 0.10 (0.05; 0.19), Stage II: HR 0.31 (0.24; 0.41)) and postoperative reoperations due to complications due to other causes than anastomotic leakage (HR 2.02 (1.21; 3.36)) were significant predictors of cancer recurrence in the multivariate Cox regression model. The association between reoperations and recurrence was strongest for the patients with the best prognosis: Stage I and Stage II-cancers. Long duration of surgery, strongly associated with blood-loss and infusions of liquid and blood-products, reoperation due to anastomotic leakage as well as right colon/transversum localization were significant at a trend-level (10%). Conclusions: Tumor stage and reoperations due to postoperative complications other than anastomotic leakage are significant predictors for recurrence after curative surgery for colorectal cancer.
Bridget, N. and Fahy, M.D. (2014) Follow-Up after Curative Resection of Colorectal Cancer. Annals of Surgical Oncology, 21, 738-746. https://doi.org/10.1245/s10434-013-3255-4
Roxburgh, C., Salmond, J. and McKee, R. (2011) Adjuvant Chemotherapy for Resected Colon Cancer: Comparison of the Prognostic Value of Tumor and Patient Related Factors. International Journal of Colorectal Disease, 26, 483-492. https://doi.org/10.1007/s00384-010-1120-5
Guercio, B.J., Sato, K., Niedzwiecki, D., Ye, X., Saltz, L.B., Mayer, R.J., Mowat, R.B., Whittom, R., Hantel, A., Benson, A., Atienza, D., Messino, M., Kindler, H., Venook, A., Hu, FB., Ogino, S., Wu, K., Willett, W.C., Giovannucci, E.L., Meyerhardt, J.A. and Fuchs, C.S. (2015) Coffe Intake, Recurrence, and Mortality in Stage III Colon Cancer: Results from CALCB 89803 (Alliance). Journal of Clinical Oncology, 33, 3598-3607. https://doi.org/10.1200/JCO.2015.61.5062
Walter, V., Jansen, L., Hoffmeister, M., Ulrich, A., Roth, W., Blaker, H., Chang-Claude, J. and Brenner, H. (2016) Prognostic Relevance of Prediagnostic Weitht Loss and Overweight at Diagnosis in Patients with Colorectal Cancer. The American Journal of Clinical Nutrition, 104, 1110-1120. https://doi.org/10.3945/ajcn.116.136531
Walter, V., Jansen, L., Ulrich, A., Roth, W., Blaker, H., Chang-Claude, J., Hoffmeister, M. and Brenner, H. (2016) Alcohol Consumption and Survival of Colorectal Cancer Patients: A Population-Based Study from Germany. The American Journal of Clinical Nutrition, 103, 1497-1506. https://doi.org/10.3945/ajcn.115.127092
Walter, V., Jansen, L., Hoffmeister, M., Ulrich, A., Chang-Claude, J. and Brenner, H. (2015) Smoking and Survival of Colorectal Cancer Patients: Population-Based Study from Germany. International Journal of Cancer, 137, 1433-1445. https://doi.org/10.1002/ijc.29511
Heald, R.J. and Ryall, R.D.H. (1986) Recurrence and Survival after Total Mesorectal Excision for Rectal Cancer. Lancet, 28, 1479-1482.
Hohenberger, W., Weber, K., Matzel, K., Papadopoulos, T. and Merkel, S. (2008) Standardized Surgery for Colonic Cancer: Complete Mesocolic Excision and Central Ligation-Technical Notes and Outcome. Colorectal Disease, 11, 354-365. https://doi.org/10.1111/j.1463-1318.2008.01735.x
Van der Sijp, M.P., Bastiaannet, E., Mesker, W.E., van der Geest, L.G., Breugom, A.J., Steup, W.H., Marinelli, A.W., Tseng, L.N., Tollenaar, R.A., van de Velde, C.J. and Dekker, J.W. (2016) Differences between Colon and Rectal Cancer in Complications, Short-Term Survival and Recurrences. International Journal of Colorectal Disease, 31, 1683-1691. https://doi.org/10.1007/s00384-016-2633-3
Nikberg, M., Chabok, A., Letocha, H., Kindler, C., Glimelius, B. and Smetdh, K. (2016) Lymphovascular and Perineural Invasion in Stage II Rectal Cancer: A Report from the Swedish Colorectal Cancer Registry. Acta Oncologica, 55, 1418-1424. https://doi.org/10.1080/0284186X.2016.1230274
Erstad, D.J., Tumusiime, G. and Cusack, J.C. Jr. (2015) Prognostic and Predictive Biomarkers in Colorectal Cancer: Implications for the Clinical Surgeon. Annals of Surgical Oncology, 22, 3433-3450. https://doi.org/10.1245/s10434-015-4706-x
Tie, J., Wang, Y., Tomasetti, C., Li, L., Springer, S., Kinde, I., Silliman, N., Tacey, M., Wong, H.L., Christie, M., Kosmider, S., Skinner, I., Wong, R., Steel, M., Tran, B., Desai, J., Jones, I., Haydon, A., Hayes, T., Price, T.J., Strausberg, R.L., Diaz, L.A., Papadopoulos, N., Kinzler, K.W., Vogelstein, B. and Gibbs, P. (2016) Circulating tumor DNA Analysis Detects Minimal Residual Disease and Predicts Recurrence in Patients with Stage II Colon Cancer. Science Translational Medicine, 8, 346ra92.
Matikas, A., Voutsina, A., Trypaki, M. and Georgoulias, V. (2016) Role of Circulating Free DNA in Colorectal Cancer. World Journal of Gastrointestinal Oncology, 8, 810-818. https://doi.org/10.4251/wjgo.v8.i12.810
Erstad, D.J., Tumusiime, G. and Cusack, J.C. (2015) Prognostic and Predictive Biomarkers in Colorectal Cancer: Implications for the Clinical Surgeon. Annals of Surgical Oncology, 22, 3433-3450. https://doi.org/10.1245/s10434-015-4706-x
Jones, F.S. and Rous, P. (1914) On the Cause of the Localization of Secondary Tumors at Points of Injury. The Journal of Experimental Medicine, 20, 404-412. https://doi.org/10.1084/jem.20.4.404
Walter, N.D., Rice, P.L., Redente, E.F., Kauvar, E.F., Lemond, L., Aly, T., Wanebo, K. and Chan, E.D. (2011) Wound Healing after Trauma May Predispose to Lung Cancer Metastasis. American Journal of Respiratory Cell and Molecular Biology, 44, 591-596. https://doi.org/10.1165/rcmb.2010-0187RT
Shine, T. and Wallack, M.K. (1981) Inflammatory Oncotaxis after Testing the Skin of the Cancer Patient. Cancer, 47, 1325-1328. https://doi.org/10.1002/1097-0142(19810315)47:6 3.0.CO;2-B
Dahl, F.A., Grotle, M., Saltyte Benth, J. and Natvig, B. (2008) Data Splitting as a Countermeasure against Hypothesis Fishing: With a Case Study of Predictors for Low Back Pain. European Journal of Epidemiology, 23, 237-242. https://doi.org/10.1007/s10654-008-9230-x
Park, E.J., Baik, S.H., Kang, J., Hur, H., Min, B.S., Lee, K.Y. and Kim, N.K. (2016) The Impact of Postoperative Complications on Long-term Oncologic Outcomes After Laparoscopic Low Anterior Resection for Rectal Cancer. Medicine (Baltimore), 95, e3271. https://doi.org/10.1097/MD.0000000000003271
Kang, J., Choi, G.S., Oh, J.H., Kim, N.K., Park, J.S., Kim, M.J., Lee, K.Y. and Baik, S.H. (2015) Multicenter Analysis of Long-Term Oncologic Impact of Anastomotic Leakage after Laparoscopic Total Mesorectal Excision: The Korean Laparoscopic Colorectal Surgery Study Group. Medicine (Baltimore), 94, e1202. https://doi.org/10.1097/MD.0000000000001202
Bell, S.W., Walker, K.G., Rickard, M.J., Sinclair, G., Dent, O.F., Chapuis, P.H. and Bokey, E.L. (2003) Anastomotic Leakage after Curative Anterior Resection Results in a Higher Prevalence of Local Recurrence. British Journal of Surgery, 90, 1261-1266.
Lu, Z.R., Ranendran, N., Lynch, A.C., Heriot, A.G. and Warrier, S.K. (2016) Anastomotic Leaks after Restorative Resections for Rectal Cancer Compromise Cancer Outcomes and Survival. Diseases of the Colon & Rectum, 59, 236-244. https://doi.org/10.1097/DCR.0000000000000554
Krarup, P.-M., Nordholm-Carstensen, A., Jorgensen, L.N. and Harling, H. (2014) Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality after Curative Resection for Colonic Cancer. Annals of Surgery, 259, 930-938. https://doi.org/10.1097/SLA.0b013e3182a6f2fc
Katoh, H., Yamashita, K., Wang, G., Sato, T., Nakamura, T. and Watanabe, M. (2011) Anastomotic Leakage Contributes to the Risk for Systemic Recurrence in Stage II Colorectal Cancer. Journal of Gastrointestinal Surgery, 15, 120-129. https://doi.org/10.1007/s11605-010-1379-4
Walker, K.G., Bell, S.W., Rickard, M.J.F.X., Mehanna, D., Dent, O.F., Chapuis, P.H. and Bokey, E.L. (2004) Anastomotic Leakage Is Predictive of Diminished Survival after Potentially Curative Resection for Colorectal Cancer. Annals of Surgery, 240, 255-259. https://doi.org/10.1097/01.sla.0000133186.81222.08
Park, E.J., Baik, S.H., Kang, J., Hur, H., Min, B.S., Lee, K.Y. and Kim, N.K. (2016) The Impact of Postoperative Complications on Long-Term Oncologic Outcomes after Laparoscopic Low Anterior Resection for Rectal Cancer. Medicine (Baltimore), 95, e3271. https://doi.org/10.1097/MD.0000000000003271
Atsushi, I., Mitsuyoshi, O., Kazuya, Y., Syuhei, K., Noriyuki, K., Masashi, M., Akira, W., Kentaro, S., Nobuyuki, K., Natsuko, S., Jun, W., Yasushi, I., Chikara, K. and Itaru, E. (2016) Long-Term Outcomes and Prognostic Factors of Patients with Obstructive Colorectal Cancer: A Multicenter Retrospective Cohort Study. World Journal of Gastroenterology, 22, 5237-5245. https://doi.org/10.3748/wjg.v22.i22.5237
Velásquez, J.F. and Cata, J.P. (2015) Transfusions of Blood Products and Cancer Outcomes. Revista Espa?ola de Anestesiología y Reanimación, 62, 461-467. https://doi.org/10.1016/j.redar.2015.02.013
Talukder, Y., Stillwell, A.P., Siu, S.K. and Ho, Y.H. (2014) Comparing Survival and Recurrence in Curative Stage I to III Colorectal Cancer in Transfused and Nontransfused Patients. International Surgery, 99, 8-16. https://doi.org/10.9738/INTSURG-D-13-00141.1
Acheson, A.G., Brookes, M.J. and Spahn, D.R. (2012) Effects of Allogeneic Red Blood Cell Transfusions on Clinical Outcomes in Patients Undergoing Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis. Annals of Surgery, 256, 235-244. https://doi.org/10.1097/SLA.0b013e31825b35d5
Qiu, L., Wang, D.R., Zhang, X.Y., Gao, S., Li, X.X., Sun, G.P. and Lu, X.B. (2016) Impact of Perioperative Blood Transfusion on Immune Function and Prognosis in Colorectal Cancer Patients. Transfusion and Apheresis Science, 54, 235-241. https://doi.org/10.1016/j.transci.2015.07.004
Donohue, J.H., Williams, S., Cha, S., Windschit, H.E., Witzig, T.E., Nelson, H., Fitzgibbons, R.J., Wieand, S. and Moerte, C.G. (1995) Peroperative Blood Transfusions Do Not Affect Disease Recurrence of Patients Undergoing Surgery for Colorectal Carcinoma: A Mayo/North Central Cancer Treatment Group Study. Journal of Clinical Oncology, 13, 1671-1678. https://doi.org/10.1200/JCO.1995.13.7.1671
Cui, J., Deng, J., Ding, X., Zhang, L., Zhang, R., Wu, W., Hao, X. and Liang, H. (2016) Blood Transfusion Does Not Affect Survival of Gastric Cancer Patients. Journal of Surgical Research, 200, 98-104. https://doi.org/10.1016/j.jss.2015.07.019
Slanetz, C.A. (1984) The Effect of Inadvertent Intraoperative Perforation on Survival and Recurrence in Colorectal Cancer. Diseases of the Colon & Rectum, 27, 792-797. https://doi.org/10.1007/BF02553942
Asano, H., Kojima, K., Ogino, N., Fukano, H., Ohara, Y. and Shinozuka, N. (2016) Postoperative Recurrence and Risk Factors of Colorectal Cancer Perforation. International Journal of Colorectal Disease, 32, 419-424. https://doi.org/10.1007/s00384-016-2694-3
Liska, D., Stocchi, L., Karagkounis, G., Elagili, F., Dietz, D.W., Kalady, M.K., Kessler, H., Remzi, F.H. and Church, J. (2016) Incidence, Patterns, and Predictors of Locoregional Recurrence in Colon Cancer. Annals of Surgical Oncology, 24, 1093-1099. https://doi.org/10.1245/s10434-016-5643-z
Skipper, D., Cooper, A.J., Marston, J.E. and Taylor, I. (1987) Exfoliated Cells and in Vitro Growth of Colorectal Cancer. British Journal of Surgery, 74, 1049-1052. https://doi.org/10.1002/bjs.1800741130
Augestad, K.M., Bakaki, P.M., Rose, J., Crawshaw, B.P., Lindsetmo, R.O., Dorum, L.M., Koroukian, S.M. and Delaney, C.P. (2015) Metastatic Spread Pattern after Curative Colorectal Cancer Surgery. A Retrospective, Longitudinal Analysis. Cancer Epidemiology, 39, 734-744. https://doi.org/10.1016/j.canep.2015.07.009