Surgical Resection Following Exploratory Laparotomy for Peritoneal Recurrence of Colorectal Cancer

Haruhiko Naito, Tatsuya Orima, Nozomi Minagawa, Tomonori Hamada, Hiroshi Shiroto, Seiichi Minami, Hirofumi Adachi, Keishi Kondo and Masami Ogita

Department of Surgery, Sapporo National Hospital/Hokkaido Cancer Center

Intraabdominal recurrence of colorectal cancer is associated with a dismal prognosis. We hypothesized that reoperation with resection of recurrent disease may augment survival. Eighteen patients with postoperative peritoneal recurrence were studied. Eleven patients comprised the nonoperative "conservative group" while 7 patients, the "operative group", were treated with resection of macroscopic recurrent disease followed by the intraperitoneal injection of MMC. Four of these 7 had demonstrated only a positive CEA analysis and none had abnormal imaging studies. The follow-up outcomes for the operative group versus the conservative group included a prolonged symptom-free interval (33 mo vs 16.2 mo) and an enhanced 50% survival rate (32 mo vs 5 mo). These data suggest that in patients who are CEA positive but imaging negative, after initial resection of colorectal cancer, that exploratory laparotomy should be done to identify and resect intraabdominal recurrent disease as early as possible

Key words
colorectal cancer, peritoneal recurrence, CEA

Reprint requests
Haruhiko Naito Department of Surgery, Sapporo National Hospital
4-2 Kikusui, Shiroishi-ku, Sapporo, 003-0804 JAPAN

Accepted
October 29, 2003

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