Results of surgical treatment of nonhepatic recurrence of colorectal carcinoma.

The sites of first recurrence of colorectal cancer include liver (more than 30%), lung and locoregional disease (20-25%), other intraabdominal sites (15-20%), and elsewhere (10%). Isolated locoregional disease accounts for 5-19% of colon recurrences and 7-33% of rectal recurrences. Between 7% and 20% of locally recurrent colorectal cancer can be resected with curative intent. Overall, complete resection of a localized recurrence yields a mean survival of 33-59 months, with long-term survival achieved in 30-50% of patients. Regional recurrence of rectal cancer may require abdominal-sacral resection for adequate margins, with 5-year survival of 18-24%. Early identification (by close monitoring) and accurate staging of recurrence are essential for potentially curative resection. Long-term survival depends on extent of recurrence and completeness of resection. Symptomatic recurrence to the ovaries that requires reoperation occurs in approximately 2% of patients; presentation usually is as part of a diffuse intraabdominal process, and resection is rarely curative. Isolated pulmonary metastases occur in 2-4% of patients experiencing disease recurrence; such tumors are resectable in half of the patients. After the tumors are surgically resected, long-term survival can be expected in 30-40% of patients, with prognosis variably associated with disease-free interval, number and size of lung metastases, and location and stage of the primary tumor. Newer techniques of postoperative monitoring after resection of the primary lesion, more sensitive preoperative and intraoperative staging of recurrences, and the use of intraoperative radiation therapy may increase surgical salvage of recurrent colorectal cancer.