PREDICTORS OF INTRALUMINAL RECURRENCE AT THE ANASTOMOSIS SITE AFTER CURATIVE RESECTION FOR COLON CANCER

Abstract

Objective: The increase in the number of patients recovering from colon cancer after primary resection inevitably increases the number of patients with local recurrence. This study was conducted to investigate the predictors of intraluminal recurrence at the anastomosis site in patients who underwent curative resection for colon cancer. Material and Method: This study included 160 patients who underwent curative resection for colon cancer and had completed follow-up colonoscopy and surveillance for at least two years at our tertiary referral hospital. Patients with intraluminal recurrence were compared with those without locally recurrent disease. Patient data, including demographics, tumor characteristics, surgery type, and reconstruction technique, were reviewed. Result: The median age of the study group was 61 years, and 60% were men. A total of 25 (15.6%) patients had only intraluminal recurrence at the anastomosis site. The median time to intraluminal recurrence was 21.3 months (range, 3–71 months). Univariate analysis revealed the histopathological type, histological grade, T stage, number of metastatic lymph nodes, tumor margins, presence of tumor budding, perineural invasion, and anastomosis type as risk factors for intraluminal recurrence. Multivariate analysis revealed handsewn anastomoses (odds ratio [OR]: 45.532; 95% confidence interval (CI): 5.278–392.778), T stage (OR: 3.593; 95% CI: 1.378–9.371), and the presence of tumor budding (OR: 3.912; 95% CI: 1.306–11.715) as independent risk factors. Adjuvant chemotherapy did not affect the rate of intraluminal recurrence. Conclusion: This study suggests a relationship between tumor biology and intraluminal recurrence, and the T stage and tumor budding were the predictors.

Keywords

• Colon cancer
• intraluminal recurrence
• anastomosis site recurrence
• risk factors

REZEKTABL KOLON KANSERİNDE ANASTOMOZ HATTI NÜKSÜNE ETKİ EDEN PREDİKTİF FAKTÖRLER

Abstract

Amaç: Rezeksiyon sonrası kolon kanserinden (KK) iyileşen hastaların sayısındaki artış, lokal nüks olabilecek hastaların sayısını da artırmaktadır. Bu çalışmada, onkolojik prensiplere uygun yapılan cerrahi sonrası, cerrahi sınırlar negatif olmasına rağmen anastomoz hattında nükslerin gelişebilmesi nedeniyle, nüksün ortaya çıkmasına etki eden risk faktörlerini araştırmayı amaçladık. Gereç ve Yöntem: Bu çalışmaya, kolon kanseri için küratif rezeksiyon uygulanmış ve en az 2 yıl boyunca takip kolonoskopisi yapılan 160 hasta dahil edildi. İntraluminal nüksü olan hastalar, lokal nüks olmayan hastalarla karşılaştırılarak; hastaların demografik bilgileri, tümör özellikleri, cerrahi tipi ve rekonstrüksiyon tekniği gibi veriler incelendi. Bulgular: Çalışma grubunun medyan yaşı 61 olup, %60'ı erkek hasta idi. Toplamda 25 (%15,6) hastada sadece anastomoz bölgesinde nüks görüldü. Anastomoz hattı nüksünün gelişimindeki medyan süre 21,3 ay (aralık, 3–71 ay) olarak hesaplandı. Tek değişkenli analiz, intraluminal nüks için risk faktörleri olarak histopatolojik tip, histolojik derece, T evresi, metastatik lenf nodu sayısı, tümör kenarları, tümör tomurcuklanması varlığı, perinöral invazyon ve anastomoz tipini ortaya koydu. Çok değişkenli analiz, el ile yapılan anastomozlar (odds oranı [OR]: 45.532; %95 güven aralığı (GA): 5.278–392.778), T evresi (OR: 3.593; %95 GA: 1.378–9.371) ve tümör tomurcuklanmasının varlığı (OR: 3.912; %95 GA: 1.306–11.715) olarak bağımsız risk faktörlerini ortaya koydu. Adjuvan kemoterapinin, anastomoz hattı nüks oranını etkilemediği görüldü. Sonuç: Anastomoz hattı nüksüne etki eden prediktif faktörler arasında, tümörün histopatolojik özellikleri ve T evresi ön plana çıkmaktadır.

Keywords

• Kolon kanseri
• anastomoz hattı nüksü
• risk faktörü

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