Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients

Bruno Andreoni, Antonio Chiappa, Emilio Bertani, Massimo Bellomi, Roberto Orecchia, Mariagiulia Zampino, Nicola Fazio, Marco Venturino, Franco Orsi, Angelica Sonzogni, Ugo Pace, Lorenzo Monfardini, Bruno Andreoni, Antonio Chiappa, Emilio Bertani, Massimo Bellomi, Roberto Orecchia, Mariagiulia Zampino, Nicola Fazio, Marco Venturino, Franco Orsi, Angelica Sonzogni, Ugo Pace, Lorenzo Monfardini

Abstract

Background: This study evaluates the surgical morbidity and long-term outcome of colorectal cancer surgery in an unselected group of patients treated over the period 1994-2003.

Methods: A consecutive series of 902 primary colorectal cancer patients (489 M, 413 F; mean age: 63 years +/- 11 years, range: 24-88 years) was evaluated and prospectively followed in a university hospital (mean follow-up 36 +/- 24 months; range: 3-108 months). Perioperative mortality, morbidity, overall survival, curative resection rates, recurrence rates were analysed.

Results: Of the total, 476 colorectal cancers were localized to the colon (CC, 53%), 406 to the rectum (RC, 45%), 12 (1%) were multicentric, and 8 were identified as part of HNPCC (1%). Combining all tumours, there were 186 cancers (20.6%) defined as UICC stage I, 235 (26.1%) stage II, 270 (29.9%) stage III and 187 (20.6%) stage IV cases. Twenty-four (2.7%) cases were of undetermined stage. Postoperative complications occurred in 38% of the total group (37.8% of CC cases, 37.2% of the RC group, 66.7% of the synchronous cancer patients and 50% of those with HNPCC, p = 0.19) Mortality rate was 0.8%, (1.3% for colon cancer, 0% for rectal cancer; p = 0.023). Multivisceral resection was performed in 14.3% of cases. Disease-free survival in cases resected for cure was 73% at 5-years and 72% at 8 years. The 5- and 8-year overall survival rates were 71% and 61% respectively (total cases). At 5-year analysis, overall survival rates are 97% for stage I disease, 87% for stage II, 73% for stage III and 22% for stage IV respectively (p < 0.0001). The 5-year overall survival rates showed a marked difference in R0, R1+R2 and non resected patients (82%, 35% and 0% respectively, p < 0.0001). On multivariate analysis, resection for cure and stage at presentation but not tumour site (colon vs. rectum) were independent variables for overall survival (p < 0.0001).

Conclusion: A prospective, uniform follow-up policy used in a single institution over the last decade provides evidence of quality assurance in colorectal cancer surgery with high rates of resection for cure where only stage at presentation functions as an independent variable for cancer-related outcome.

Figures

Figure 1
Figure 1
Survival according to UICC tumour stage (7 patients who died peroperatively were excluded from the analysis).
Figure 2
Figure 2
(a) Survival according to UICC tumour stage for colon cancer patients undergoing surgery. (b) Survival according to UICC tumour stage for rectal cancer patients undergoing surgery.
Figure 3
Figure 3
Survival according to radicality of surgery.

References

    1. Hermanek P, Sobin CH, editors . 2nd rev 1992. 4. Budapest, Springer; 1993. TNM classification of malignant tumours; pp. 52–55.
    1. Hermanek P, Henson DE, Hutter RVP, Sobin CH, editors . TNM supplement 1993. Budapest, Springer; 1993. pp. 30–32. 122–124.
    1. Sobin LH, Wittekind CH, editors . TNM classification of malignant tumours. 5. New York Wiley; 1997. pp. 66–69.
    1. Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ, editors . American Joint Committee on Cancer (AJCC) Manual for staging of cancer. 4. Philadelphia, Lippincott; 1992. pp. pp75–79.
    1. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy PJ, Murphy GP, Sullivan PO, Sobin LH, Yarbro JW, editors . American Joint Committee on Cancer (AJCC) Cancer staging manual. 5. Philadelphia, LIPPINCOTT; 1997. pp. 83–68.
    1. Hermanek P, Wittekind C. Residual tumour ® classification and prognosis. Sem Surg Oncol. 1994;10:12–20. doi: 10.1002/ssu.2980100105.
    1. Newland RC, Dent OF, Chapuis PH, Bokey EC. Clinicopathologically diagnosed residual tumour after resection for colorectal cancer. A 20 years prospective study. Cancer. 1993;72:1536–1542. doi: 10.1002/1097-0142(19930901)72:5<1536::AID-CNCR2820720508>;2-U.
    1. Griffen FD, Knight CDSr, Whitaker JM, Knight CD., Jr The double stapling technique for low anterior resection. Results, modifications and observations. Ann Surg. 1990;211:745–752. doi: 10.1097/00000658-199006000-00014.
    1. Wittekind CH, Wagner H, editors . TNM Klassifikation maligner tumoren. 5. Berlin, Springer; 1997. pp. 87–95.
    1. Moertel CG, Fleming TR, Macdonalds JS, Haller DG, Laurie JA, Targen GM, Ungerleider JS, Emerson WA, Tomey DC, Click JH. Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med. 1995;122:321–326.
    1. Machover D, Goldschmidt E, Challet P, Metzger G, Zittoun J, Marquet J, Vandenbulcke JM, Misset JL, Schwarrzenberg L, Fourtillan JB. Treatment of advanced colorectal and gastric carcinoma with 5-fluorouracil and high-dose folinic acid. J Clin Oncol. 1986;4:685–696.
    1. Fucci L, Pirrelli M, Caruso ML. Carcinoma and synchronous hyperplastic polyps of the large bowel. Pathologica. 1994;86:371–375.
    1. Cali RL, Pitsch RM, Thorson AG, Watson P, Tapia P, Blatchford GJ, Christensen MA. Cumulative incidence of metachronous colorectal cancer. Dis Colon Rectum. 1993;36:388–393. doi: 10.1007/BF02053945.
    1. Tanaka H, Hiyama T, Hanai A, Fujimoto I. Second primary cancers following colon and cancer in Osaka, Japan. Jpn J Cancer Res. 1991;82:1356–1365.
    1. Schaaal JC, Mondino JC, Paris F, Piat JM, Jaeck D. Synchronous colorectal cancers. J Chir (Paris) 1991;128:476–480.
    1. Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF. Wound infection after elective colorectal resection. Ann Surg. 2004;239:599–605. doi: 10.1097/01.sla.0000124292.21605.99.
    1. Hermanek P, Jr, Wiebelt H, Riedl S, Staimmer D, Hermanek P. Long-term results of surgical therapy of colon cancer. Results of the Colorectal Cancer Study Group. Chirurg. 1994;65:287–297.
    1. Billingsley KG, Morris AM, Dominitz JA, Matthews B, Dobie S, Barlow W, Wright GE, Baldwin LM. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007;142:23–31. doi: 10.1001/archsurg.142.1.23. discussion 32.
    1. Bokey EL, Chapuis PH, Fung C, Hughes WJ, Koorey SG, Brewer D, Newland RC. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum. 1995;38:480–486. doi: 10.1007/BF02148847.
    1. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92:1150–1154. doi: 10.1002/bjs.5054.
    1. Hermanek P, Wiebelt H, Staimmer D, Riedl S. Tumori. Vol. 81. German Study Group Colorectal Carcinoma; 1995. Prognostic factors of rectum carcinoma: experience of the German Multicentre Study SGCRC; pp. 60–64.
    1. Konn M, Morita T, Hada R, Yamanka Y, Sasaki M, Munakata H, Suzuki H, Inoue S, Endoh M, Sugiyama Y. Survival and recurrence after low anterior resection and abdominoperineal resection for rectal cancer: the results of a long-term study with a review of the literature. Surg Today. 1993;23:21–30. doi: 10.1007/BF00308995.
    1. Kierkegaard O, Olesen B. [Prognosis of patients with rectal cancer treated in a department of general surgery] Ugeskr Laeger. 1991;153:2182–2184.
    1. Bethune WA. Carcinoma of the rectum: 508 patients with failure analysis and implication for adjuvant therapy. J Can Assoc Radiol. 1987;38:209–214.
    1. Lopez MJ, Monafo WW. Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery. 1993;113:365–372.
    1. Rowe VL, Frost DB, Huang S. Extended resection for locally advanced colorectal carcinoma. Ann Surg Oncol. 1997;4:131–136. doi: 10.1007/BF02303795.
    1. Gebhardt C, Meyer W, Ruckriegel S, Meier U. Multivisceral resection of advanced colorectal carcinoma. Langenbecks Arch Surg. 1999;384:194–199. doi: 10.1007/s004230050191.
    1. Staniunas RJ, Schoetz DJJ. Extended resection for carcinoma of colon and rectum. Surg Clin North Am. 1993;73:117–129.
    1. Izbicki JR, Hosch SB, Knoefel WT, Passlick B, Bloechle C, Broelsch CE. Extended resections are beneficial for patients with locally advanced colorectal cancer. Dis Colon Rectum. 1995;38:1251–1256. doi: 10.1007/BF02049148.
    1. Turoldo A, Balani A, Tonello C, Ziza F, Roseano M. Extended resection in locally advanced colon cancer. Ann Ital Chir. 1998;69:639–644.
    1. Link KH, Staib L, Kreuser ED, Beger HG. Adjuvant treatment of colon and rectal cancer: impact of chemotherapy, radiotherapy, and immunotherapy on routine postsurgical patient management: Forschungsgruppe Onkologie Gatrointestinaler Tumoren (FOGT) Recent Results. Cancer Res. 1996;142:311–352.
    1. Macdonald JS. Adjuvant therapy of colon cancer. CA Cancer J Clin. 1999;49:202–204.
    1. Junginger T, Hossfeld DK, Sauer R, Hermanek P. Adjuvant therapy in patients with colorectal cancer. Dt Aerztebl. 1999;96:A698.
    1. Wolmark N, Rockette H, Fisher B, Wicherham DL, Redmond C, Fisher ER, Jones J, Mamounas EP, Ore L, Petrelli NJ, Spurr C, Dimitrov N, Romond EH, Sutherland CM, Kardinal CG, DeFusco PA, Jochimsen P. The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer and bowel project protocol C-03. J Clin Oncol. 1993;11:1879–1887.
    1. Francini G, Petrioli R, Lorenzini L, Mancini S, Armenio S, Tanzini G, Marsili S, Aquino G, Marzocca G, Civitelli S. Folinic and 5-fluorouracil as adjuvant chemotherapy in colon cancer. Gastroenterology. 1994;106:899–906.
    1. Zaniboni A, Labianca R, Marsoni S, Torri V, Mosconi P, Grilli R, Apolone G, Cifani S, Tinazzi A. GIVIO-SITAC 01: a randomized trial of adjuvant 5-fluorouracil and folinic acid administered to patients with colon carcinoma-long term results and evaluation of the indicators of health-related quality of life; Gruppo Italiano Valutazione Interventi in Oncologia; Studio Italiano Terapia Adiuvante. Colon Cancer. 1998;82:2135–2144.
    1. Wils J. Adjuvant treatment of colon cancer: past, present and future. J Chemother. 2007;19:115–122.
    1. Wong R, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. 2007;18:CD002102.
    1. Jagoditsch M, Pozgainer P, Klingler A, Tschmelitsch J. Impact of blood transfusions on recurrence and survival after rectal cancer surgery. Dis Colon Rectum. 2006;49:1116–1130. doi: 10.1007/s10350-006-0573-7.
    1. Castells A, Bessa X, Daniels M, Ascaso C, Lacy AM, Garcia-Valdecasas JC, Gargallo L, Novell F, Astudillo E, Filella X, Pique JM. Value of postoperative surveillance after radical surgery for colorectal cancer: results of a cohort study. Dis Colon Rectum. 1998;41:714–723. doi: 10.1007/BF02236257.
    1. Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET) Ann Surg. 2004;240:438–447. doi: 10.1097/01.sla.0000138076.72547.b1.
    1. Joyce DL, Wahl RL, Patel PV, Schulick RD, Gearhart SL, Choti MA. Preoperative positron emission tomography to evaluate potentially resectable hepatic colorectal metastases. Arch Surg. 2006;141:1220–1226. doi: 10.1001/archsurg.141.12.1220.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere