Local and regional recurrence of carcinoma of the colon and rectum: II. Factors relating to operative technique.

Despite many recent advances in the field of radiation therapy, chemotherapy and even immunotherapy, surgical resection remains the mainstay of curative treatment for carcinoma of the colon and rectum. Locoregional recurrence is a recognized type of failure, and it is the most direct measurement of the relevance of surgery to cancer control. Factors that influence relapse rates and sites deserve in-depth and periodical review. Local or locoregional (LR) recurrence implies the reappearance of carcinoma after an intended complete removal of the tumour. It is usually defined as tumour regrowth at the anastomosis or immediately within or contiguous to the operative area. For rectal cancer, the adjacent organs include the perineum, bladder and vagina; and LR failure includes perineal or pelvic lesions. Many reports studied only patients with colon or rectal cancers, while others presented their data of the colon and rectum together. In this review, I shall use colon, rectum and colorectum to designate the composition of each patient population. Published results from all available English sources were reviewed, concentrating on reports of the last 10 years. Data analysed by statistical methods are emphasized, and a probability of occurrence of one in 20 or less (P < 0.05) is considered significant. Various clinicopathological factors of the tumour and host, and adjuvant radiotherapy that affected the LR recurrence rates have been presented in another paper (part 1, 283 - 293). Technical details and issues relating to performance of the operation will be discussed in this paper (part II). Quantitative information presented here predate the wide use of laparoscopic or minimal invasive surgery in treating the primary tumour, and the polar practice of periodic colonoscopy, carcinoembryonic antigen (CEA) or computed tomography as regular follow-up tests. Thus, these baseline data will be useful to study the changes in rates and sites of recurrence in the future.