Pattern of relapse after curative surgery for metastatic colorectal cancer.

OBJECTIVE: To investigate patterns in the relapse frequency after curative surgical intervention, with the intention of determining the feasibility of a complete holiday from chemotherapy for metastatic colorectal cancer (mCRC) patients. METHODS: Patients with stage IV mCRC who received curative surgical intervention between January 1999 and December 2009 at Changhua Christian Hospital, Changhua, Taiwan were investigated retrospectively. Factors influencing the frequency and pattern of relapse were analyzed by logistic regression. Factors influencing overall survival (OS) were analyzed with Cox proportional hazard ratios. Significant factors were extracted and relationships to OS were evaluated by Kaplan-Meier with Log-Rank test. RESULTS: One hundred and thirty-two patients were included in the study in which 94 (71.2%) suffered from relapse. The number of relapses peaked between 3 and 6 months. The incidence of relapse and Disease-free survival had a negative influence on OS, with a hazard ratio (HR) of 0.36 (95% CI: 0.01-0.26) and 0.93 (95% CI: 0.90-0.95). The prognosis was significantly worse when the relapse (n=25) occurred within 6 months after metastectomy (p<0.001). Patients exhibited significantly better long-term OS if the relapse does not occur within 28 months after surgery (p<0.001). CONCLUSION: Early relapse indicated a worse prognosis. We determined that if mCRC patients remain cancer-free for 28 months after curative surgery, their chance of long-term survival is significantly better.

Missed cancerous lesions in emergency laparoscopic surgery: retrospective study of 2074 cases.

Abdominal laparoscopy is a widely accepted surgical procedure effective even for acute abdominal ailments. However, one major concern in using abdominal laparoscopy is missed lesions, in the past this has not been adequately explored. The aim of this retrospective study, therefore, is to evaluate cancerous lesions that are missed during emergency laparoscopic surgeries. The medical records of 2074 patients who had a laparoscopy from March 1996 to April 2006 for acute abdomen symptoms, including diagnostic laparoscopy (n = 119), laparoscopic appendectomy (n = 1336), laparoscopic duodenorrhaphy (n = 30), and laparoscopic cholecystectomy (n = 589) were reviewed. Missed cancerous lesions included cecal cancer (n = 2), sigmoid cancer (n = 1), and jejunum lymphoma (n = 1). The incidence of missed cancerous lesions in an emergency laparoscopic surgery is 0.19%, mainly due to its lower tactile sensitivity compared to the direct hand palpation and masqueraded by inflammatory process. Therefore, careful observation is recommended for post-emergency laparoscopic patients and follow-up should be performed within three months, especially for patients with intra-abdominal and/or severe inflammation status.

Effect of preoperative concurrent chemoradiotherapy in locally advanced low rectal cancer after radical resection surgery.

To evaluate the outcome of patients with locally advanced low rectal adenocarcinoma who required preoperative concurrent chemoradiotherapy (CCRT), a total of 22 patients underwent preoperative CCRT and radical resection for locally advanced low rectal adenocarcinoma. Patients received concurrent chemotherapy with high-dose 5-fluorouracil (5-FU) in continuous infusion and leucovorin and preoperative radiation with a mean dose of 50.4 Gy (range, 45-50.4 Gy). Radical resection surgery was performed 6 weeks after treatment. Fifty-five percent of patients achieved tumor downstaging, and 14% patients. showed pathological complete remission. No severe hematological and gastrointestinal toxicity of preoperative CCRT was noted. Sphincter-saving rate was 82%, and there were no deaths related to preoperative CCRT and surgery. Overall, 3-year survival rate was 69%, and a rate of locoregional recurrence was 13.6%. This study shows that many patients with locally advanced rectal cancer can be operated on with sphincter-saving radical resection surgery under good local control after preoperative concurrent chemoradiotherapy, which induces tumor downstaging.