Minimizing locoregional recurrences in colorectal cancer surgery

Follow-up of colorectal cancer and patterns of recurrence

Colorectal cancer is one of the commonest cancers detected as also amongst the most common causes of cancer death. Survival has improved due to better disease understanding and treatment; however, a substantial proportion of patients recur after curative intent therapy. In this article, we will discuss the imaging features of recurrent colorectal cancer and the role of the radiologist in its management.

Pattern, Stage, and Time of Recurrent Colorectal Cancer After Curative Surgery

Surgery remains the mainstay of curative treatment for colorectal cancer (CRC). Despite curative surgery, some patients experience cancer recurrence. However, the pattern, stage, and time of recurrent disease (RD) remain unknown. We aimed to determine the pattern and stage of RD after curative open and laparoscopic surgery for CRC. Databases were searched using selected keywords for clinical studies that analyzed the pattern, stage, and time of RD from CRC. A systematic protocol was used for data extraction, data synthesis, and interpretation of results. Of 455 publications retrieved from databases, 9 clinical studies were selected for this systematic review. There is substantial evidence that pulmonary recurrence is most commonly associated with rectal tumors, and multisite RD appears more frequently with right-sided CRC. RD from colon cancers predominantly appears early in liver, while recurrences from rectal cancer appear late in lungs. Approximately 30% to 50% of RD after curative resection of CRC occurs within the first 2 years; however, median time to recurrence is gradually increasing, particularly for patients with rectal cancers. Advanced primary CRC is significantly correlated with more locoregional and distant RD, with worse disease-free survival. There is a decrease in the 5-year incidence of RD that is associated with prolongation of time of RD for both locoregional and metastatic disease. The duration and design of postoperative follow-up protocols for recurrences from CRC should be tailored to site and stage of primary tumor, as rectal cancers demand longer surveillance times than colon cancer.