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Loco-regional Recurrence from Colon Cancer: A Population-based Study

¹ Department of Surgery, P9:03, Karolinska University Hospital, Solna, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
² Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
³ Department of Oncology and Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

Correspondence: Address correspondence and reprint requests to: Annika Sjövall; E-mail: annika.sjovall{at}karolinska.se

Background: The survival after colon cancer surgery has not improved to the same extent as after rectal cancer treatment and studies on loco-regional recurrence after colon cancer surgery are scarce. The aim of this study was to assess the problem of loco-regional recurrence after potentially curative resections for colon cancer, regarding incidence, risk factors, management, and outcome.

Methods: All 1,856 patients submitted to potentially curative surgery for colon cancer in the Stockholm/Gotland region in Sweden between 1996 and 2000 were followed until January 2005 or until death. Follow-up data were prospectively collected. Risk factors for loco-regional recurrences were analyzed, treatment and outcome for patients with recurrence was studied.

Results: The cumulative 5-year incidence of loco-regional recurrence was 11.5%. Tumor locations in the right flexure and in the sigmoid colon, bowel perforation and emergent surgery were identified as independent risk factors for loco-regional recurrence. The risk also increased with increasing T- and N-stage.

The median survival for all 192 patients with loco-regional recurrence was 9 months. Surgery was performed in 110 (57%) patients. In 23 (12%) patients a complete tumor clearance was achieved and the estimated 5-year survival in this group was 43%.

Conclusion: Loco-regional recurrence from colon cancer is a significant clinical problem. A multidisciplinary treatment approach, including preoperative staging, a complete resection of the recurrence and more effective adjuvant treatments may improve the outcome.

Key Words: Colon cancer • Loco-regional recurrence • Population-based • Risk factors