Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum.

The records of 525 patients with adenocarcinoma of the colon and rectum were reviewed. Two hundred and eighty-five patients were evaluable following complete curative resections. These patients were evaluated for patterns of recurrence. The over-all recurrence rate was 78 of 285, 27 per cent. The over-all recurrence rate by site was 24.0, 10.0, 11.5 and 35.0 per cent for the right, transverse and left colon, the sigmoid and the rectum, respectively. The over-all failure rate by stage was 13 per cent for Stage A, 11 per cent for Stage B1, 32 per cent for Stage C1, 37 per cent for Stage B2-3 and 56 per cent for Stage C2-3. The over-all failure rate as related to Stages A, B1, C1, B2-3 and C2-3 and to site of primary disease was: right--zero, 9, 33, 28 and 43 per cent, sigmoid--11, 15, 40, 52 and 62 per cent; rectal group--29, 14, 40, 46 and 60 per cent as related to respective stages. There was one failure among the five patients with Stage B2-3 disease in the transverse group and two failures among the nine patients with Stage B2-3 and one failure in the one patient with Stage C2-3 within the left colon group. Individual types of failure were compiled. Lesions involving the rectum and sigmoid colon had a significant local-regional component to relapse. Tumors of the right, transverse and the left colon had a significant distant recurrence rate. Factors of primary site, age at diagnosis, extent of disease and histology were reviewed as to the over-all recurrence and specific failure sites. From this analysis, a schema involving patterns of failure as related to primary site and stage within the colon, rectum and sigmoid were developed.