Detection of Recurrences During Follow-up After Liver Surgery for Colorectal Metastases: Both Carcinoembryonic Antigen (CEA) and Imaging are Important (original) (raw)
Related papers
Surgery Today, 2006
Greece gery in 25% of patients undergoing curative surgery. 1,2 Occult metastases smaller than 1 cm in diameter often remain undiagnosed, despite advanced diagnostic techniques. Moreover, although the therapeutic outcome of patients with colorectal cancer is improving, almost half of these patients will die of recurrent or metastatic disease. Since the isolation of carcinoembryonic antigen (CEA) from extracts of gastrointestinal tract tumors and fetal gut tissue in 1965, the detection of CEA in other fluids has been used by many clinicians. 1,2,5 Yeatman et al. suggested that the biliary concentration of CEA was a sensitive marker of occult hepatic metastases and hypothesized that CEA secreted from liver metastases may be transported into the bile as well as into the blood. Thus, the concentrations of bile CEA may be detectable at an earlier stage as gallbladder bile is concentrated 10-12 times, making bile CEA a more sensitive marker for liver metastases. Other authors have since evaluated the role of bile CEA as well as peripheral and mesenteric venous blood CEA levels, in predicting hepatic metastases and the prognosis of colorectal cancer patients. In this prospective study, we measured CEA levels in peripheral, mesenteric venous blood, and bile from patients with colorectal cancer without metastases, and investigated their possible role in predicting hepatic metastases, local recurrence, and survival. We also evaluated the relationship between the CEA positive rates and four clinicopathologic variables; namely, tumor location, differentiation, tumor staging, and the existence of nodal metastases.
Predictors of early recurrence after resection of colorectal liver metastases
World Journal of Surgical Oncology, 2015
Background: Early recurrence after resection of colorectal liver metastases (CLM) is common. Patients at risk of early recurrence may be candidates for enhanced preoperative staging and/or earlier postoperative imaging. The aim of this study was to determine if there are any risk factors that specifically predict early liver-only and systemic recurrence. Methods: Retrospective analysis of prospective database of patients undergoing liver resection (LR) for CLM from 2004 to 2006 was undertaken. Early recurrence was defined as occurring within 18 months of LR. Patients were classified into three groups: early liver-only recurrence, early systemic recurrence and recurrence-free. Preoperative factors were compared between patients with and without early recurrence.
Japanese Journal of Clinical Oncology, 2006
Early recurrence is a major problem after hepatic resection of colorectal hepatic metastasis (CHM). Our aim was to investigate the relationship between time to recurrence after CHM resection and overall survival. A retrospective analysis was performed for 101 consecutive patients who underwent hepatic resection for CHM and have been followed more than 5 years. Among 101 patients, 82 (81%) had a recurrence. Overall survival of patients with recurrence within 6 months after CHM resection was significantly worse than that of patients with recurrence after more than 6 months (P < 0.01). Overall survival was poorer when time to recurrence was shorter. One of the reasons for poor prognosis of patients with recurrence within 6 months was that only a few patients could undergo a second resection for recurrence after CHM resection. Histological type, including poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor, bilobar metastases, microscopic positive surgical margin and carcinoembryonic antigen (CEA) above 15 ng/ml had predictive value for decreased recurrence-free survival after CHM resection. Short time to recurrence after CHM resection correlates with a poor prognosis. Histological type of poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor might be a predictor for early recurrence after CHM resection.
American Journal of Roentgenology, 1994
Despite studies showing increased survival rates for patients after surgical resection of hepatic metastases, recurrences occur in 75% of treated patients. The purpose of this study was to determine the location and time of discovery of recurrent tumor on CT scans after resection of hepatic metastases from cobrectal carcinoma. MATERIALS AND METHODS. In a 6-year period, 32 patients (16 men and 16 women) who had undergone partial hepatic resection for colorectal metastases had follow-up CT at our institution. A total of 125 CT examinations of the chest and abdomen were retrospectively reviewed for the presence and location of recurrent disease. Recurrence was either confirmed by biopsy (n = 12) or presumed on the basis of growth of new lesions (n = 17). RESULTS. With a mean follow-up of 22 months (range, 1-60 months), recurrence was found at 29 sites in 25 patients. Thirteen sites were hepatic, and 16 were extrahepatic. Three patients had both hepatic and pulmonary disease. Recurrence within the liver was away from surgical margins in 11 (85%) of 13 patients at 14 ± 7 months and adjacent to a surgical margin in the remaining two patients (15%) at 17 ± 1 months. Extrahepatic recurrences were discovered in the lung in 11 (69%) of 16 patients at 21 ± 12 months; in an adrenal gland in two patients (13%) at 19 ± 5 months; in lymph nodes of the porta hepatis in one patient (6%) at 11 months; at the primary colonic anastomosis in one patient (6%) at 3 months; and in a retroperitoneal lymph node in the remaining patient (6%) at 1 2 months. CONCLUSION. Surgery was effective in treating the preoperatively detected hepatic metastases. Only two of 25 patients had recurrence related to a hepatic surgical margin. Most recurrences occur more than 1 year after surgery, most often in lung or liver away from surgical margins, and they probably represent small metastases undetectable with current preoperative or intraoperative techniques.
Surveillance after colorectal cancer surgery
European Journal of Surgical Oncology (EJSO), 1997
Early diagnosis of local and distant recurrences of colorectal cancer remains difficult and there is no agreement on the effectiveness of follow-up in these patients. The aim of this study is to assess the value of our method of follow-up. We consider.239 patients with coiorectal cancer and at least 2 years follow-up following radical resection. A local recurrence appeared in 26 patients (10.9%), a distant metastasis in 41 (17.1%), while in seven (2.9%) local and distant recurrences appeared simultaneously. Local recurrence was detected because of an increase in carcinoembryonic antigen (CEA) level in' 15 patients (57.7%), during a scheduled endoscopy in four (15.4%) and because of symptoms in seven (26.9%). in seven patients (26.9%) a radical resection was possible. Distant metastases were detected by CEA levels in 20 patients (48.8%), by ultrasonography (U.S.) in 12 (29.3%) and by chest X-ray in five (12.2%). In 13 of 26 patients with liver metastases a resection was performed. This study shows that few patients benefit from follow-up and only CEA levels and liver U.S. performed intensively between 15 and 36 months after surgery are useful in early detection of recurrences. A modification of the follow-up to the single patient, according to the stage, location and grading of cancer, could improve the results, so lowering the costs of this expensive practice.
Outcome following repeat liver resection for colorectal liver metastases
European Journal of Surgical Oncology (EJSO), 2007
Aim: Our aim was to determine independent predictors of survival after second liver resection and to confirm whether the type of first resection influences survival after repeat resection. Methods: Fifty-four patients who underwent a second liver resection for colorectal liver metastases were analyzed. To find independent predictors of survival, possible prognostic factors regarding the primary tumor, and the first and second resections were used in the Cox regression analysis. Results: There were three postoperative deaths within 90 days of surgery. The 3-and 5-year overall survival rates were 53% and 46%, respectively. The size of the tumor (>50 mm) ( p ¼ 0.005), serum carcinoembryonic antigen level (>30 mg/L) ( p ¼ 0.002), and the presence of a positive surgical margin at the second resection ( p ¼ 0.006) were independent predictors of poor survival following the second resection. The type of first resection was not associated with survival but was associated with the ability to achieve a histological negative surgical margin at the second liver resection ( p ¼ 0.01). Conclusion: Three independent predictors of survival were identified. Major initial liver resection was associated with a reduced ability to achieve surgical clearance at the second resection. For colorectal liver metastases, major resection should only be performed if a negative margin cannot be achieved by minor resection.
Management of intrahepatic recurrence after curative treatment of colorectal liver metastases
British Journal of Surgery, 2006
Background Management of intrahepatic recurrence after complete surgical treatment for colorectal liver metastases is not well defined. The aim of this study was to analyse the survival results of patients who had repeat liver resection for intrahepatic recurrence and to evaluate prognostic indicators for survival. Methods Between 1991 and 2005, 55 patients had repeat liver resection for isolated intrahepatic recurrence. The long-term survival results were assessed. Univariable and multivariable analyses were used to identify prognostic indicators for survival after repeat hepatectomy. Results The median survival was 53 (range 2–97) months and the 5-year survival rate was 49 per cent. In univariable analysis, size of largest initial liver metastasis, margin of initial liver surgery, carcinoembryonic antigen (CEA) level before and after initial liver surgery, liver disease-free survival, margin of repeat liver surgery, operation type of repeat surgery and CEA level before and after r...