Clinical Study of Multiple Carcinomas of the Colon and Rectum

Shiro Nakae, Katsunori Kawaguchi, Hidehiro Sawa, Ippei Matsumoto, Manabu Takamatsu, Tsuyoshi Hamaoka, Kunihiko Kaneda, Sumio Fujiwara, Yoshihiro Kanbara and Norio Kohno

Department of Surgery, Hyogo Medical Center for Adults

Introduction: The present study was carried out to clarify the clinical characteristics of multiple colorectal carcinomas and to consider the recommended postoperative follow up. Method: We examined the clinical backgrounds of patients with multiple colorectal cancers and compared them with those of patients with solitary cancer. 828 patients underwent surgery for colorectal carcinoma at our institute in the last 16 years. Result: Among them, 64 patients (7.7%) had multiple lesions, including 47 (5.7%) synchronous and 17 (2.1%) metachronous, ones. Tumor distribution did not differ significantly between single and synchronous multiple cases. In metachronous cases, primary carcinomas were predominantly located in the left colon. Time interval of metachronous occurrence ranged to 18 years, averaging 7.25 years. Association of adenomatous polyps was found to be high at 93.3% in multiple colorectal cancers, compared to 73.1% in solitary cases. The frequency of gastric cancer was 12.8% in synchronous multiple colorectal cancers, but only 4.8% in solitary colorectal cancer. In cases where proximal colon could not be examined, or adenomatous polyps were detected preoperatively and regular postoperative follow-up with total colon fiberscopy was lacking, the diagnosis of a secondary metachronous colorectal cancer tended to be late. Discussion: The patients with a history of surgery for colorectal cancer, especially having adenomatous polyps, a history of gastric cancer, and/or a family history of colorectal cancer were considered to have higher risk of developing multiple colorectal cancers. Taking those factors into consideration, surveillance by total colon fiberscopy should be performed for early detection of a secondary metachronous cancer.

Key words
multiple colorectal cancers, synchronous colorectal cancers, metachronous colorectal cancers, preoperative examination of colorectal cancer, postoperative follow-up of colorectal cancer

Reprint requests
Shiro Nakae Department of Surgery, Hyogo Medical Center for Adults 36-1 Tsukaguchi-cho, Amagasaki, 661-0002 JAPAN

Accepted
September 19, 2001

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