CEA and relapse after the operation of colorectal carcinoma.

BACKGROUND: Relapses have an important meaning in relation to the curative surgical intervention. In RO resections according to UICC classification, the local relapses were classified as the most important factor for survival. Without any doubts the most important of these tumor-biological prognostic factors in patients with colorectal carcinoma is the carcino-embryonal antigen. Up to now, the unquestionable importance of the determination of serum levels of CEA for the detection of relapses is most often described. MATERIAL AND METHODS: This study is retrospective, not randomized. Analyzed were medical records and data of patients, who underwent the surgery of colorectal carcinoma at IInd Department of Surgery, University Hospital, Faculty of Medicine, Comenius University, Bratislava, in period from January 1st, 1986 to December 31st, 1995. In our analysis we evaluate the age and gender of patients, date of the surgery and type of the surgery from the point of acuteness, as well as radicality, staging of the disease, levels of the serum CEA. Serum levels of carcino-embryonal antigen before operation were determined and evaluated. In patients, who remaind in the monitoring at our department we examine CEA in regular intervals. RESULTS: From our group of patients, in 28 patients the relapse of the disease was determined here. Before the first operation, the preoperative level of CEA was examined in 15 patients and in 13 patients it was not. From 15 patients with examined CEA level, 7 patients (46.7%) had increased and 9 patients (53.3%) normal level. In twenty-seven patients CEA level was examined to reveal a relapse. One patient was diagnosed during the acute surgery and CEA was not determined prior this operation. From the remaining 27 patients, CEA level was positive in 20 patients (74.1%) and 7 patients had normal levels (25.9%). From these 7 patients with normal CEA level, in 5 cases it was locoregional relapse and 2 patients have distant metastases. From all patients, in whom the relapse was determined at our department, in 13 patients locoregional relapse was detected and in 15 patients distant metastases were diagnosed. CONCLUSION: Due to the sensitivity of serum level of CEA for detection of relapses, which is higher compared to the primary tumor and also to found lead time 4 months we think the postoperative regular determination of CEA in patients after the curative resection is appropriate. Earlier determination of less progressive relapse is definitely important, although the current long-term survival after the surgery for relapses is not optimistic. Development of surgical procedures as well as alternative treatment can bring better results in less developed relapse of the disease. (Ref. 28.).

[Preoperative levels of CEA and survival in patients with surgical treatment of colorectal carcinoma]. / Predoperacná hladina CEA a prezívanie pacientov operovaných na kolorektálny karcinóm.

From the 1st January 1986 until the 31st December 1995 397 patients were operated on at the IInd Surgical Clinic of Medical Faculty, Comenius University in Bratislava because of colorectal cancer. Of them 325 patients were operated on electively and 72 patients were operated on as emergency cases. The authors analysed average survival time and the relationship between survival and preoperative level of CEA. The average survival time, without dividing into stages was 37.3 months, not involving patients with perioperative lethality of 43.1 months. 5 years survival without dividing into stages was 36.8%. Average survival of patients without dividing into stages with increased preoperative level of CEA was 28.7 months, in patients without increased level of CEA it was 42.5 months. 5-years survival in patients with normal preoperative level of CEA was 60.5%, in patients with increased level of CEA it was 35.7%. There was highest difference when dividing to subgroups based upon the stage of the disease between groups with stage pT4N0M0 and pT1-4N1-3M0. The positiveness or negativeness of the preoperative level of CE supports the staging of disease and supposes a significant difference in 5-years survival in patients especially in the mentioned stages. Although this difference is obvious, it is not possible to suppose individual prognosis of patients and the necessity of an adjuvant therapy. (Tab. 2, Ref. 31.)

[The effect of age and risk factors on postoperative complications and mortality in patients with surgery for colorectal carcinoma]. / Vplyv veku a rizikových faktorov na pooperacné komplikácie a letalitu pacientov operovaných pre kolorektálny karcinóm.

The authors analyzed the risk factors and their impact on perioperative complications and mortality in aged patients electively operated due to colorectal cancer at the II. Surgical Clinic LFUK in Bratislava during the period from January 1, 1986 to October 31, 1994. The patients were divided into three groups according to WHO criteria, those younger than 65, from 65 to 75, and older than 75 years of age. The results are in correlation with the data published in literature. According to the accomplished results the age per se does not represent contraindication to surgical intervention. However, the lethality in the aged patients with two or more risk factors significantly increases. In regard to the latter the authors recommend a strictly individual consideration as to whether these patients would benefit more from palliative therapy procedures as to life prolongation and its quality improvement. (Tab. 5, Ref. 25.)