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

Yıl 2024, Cilt: 87 Sayı: 3, 185 - 193, 19.07.2024

İlker Özgür , Burak Çelik , Melek Büyük , Cemalettin Ertekin , Türker Bulut , Metin Keskin

https://doi.org/10.26650/IUITFD.1428549

Öz

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.

Anahtar Kelimeler

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

REZEKTABL KOLON KANSERİNDE ANASTOMOZ HATTI NÜKSÜNE ETKİ EDEN PREDİKTİF FAKTÖRLER

Öz

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.

Anahtar Kelimeler

Kolon kanseri, anastomoz hattı nüksü, risk faktörü

Kaynakça

• 1. Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019;69(5):363-85. [CrossRef] google scholar
• 2. Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Danish Colorectal Cancer Group. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 2015;16(2):161-8. [CrossRef] google scholar
• 3. Sargent DJ, Patiyil S, Yothers G, Haller DG, Gray R, Benedetti J, et al. End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20,898 patients enrolled in 18 randomized trials from the ACCENT Group. J Clin Oncol 2007;25(29):4569-74. [CrossRef] google scholar
• 4. Read TE, Mutch MG, Chang BW, McNevin MS, Fleshman JW, Birnbaum EH, et al. Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 2002;195(1):33-40. [CrossRef] google scholar
• 5. Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well-defined population. Br J Surg 2006;93(9):1115-22. [CrossRef] google scholar
• 6. Sjövall A, Granath F, Cedermark B, Glimelius B, Holm T. Loco-regional recurrence from colon cancer: a population-based study. Ann Surg Oncol 2007;14(2):432-40. [CrossRef] google scholar
• 7. Yun HR, Lee LJ, Park JH, Cho YK, Cho YB, Lee WY, et. Al. Local recurrence after curative resection in patients with colon and rectal cancers Int J Colorectal Dis 2008;23(11):1081-7. [CrossRef] google scholar
• 8. Costi R, Santi C, Bottarelli L, Azzoni C, Zarzavadjian Le Bian A, et al. Anastomotic recurrence of colon cancer: Genetic analysis challenges the widely held theories of cancerous cells’ intraluminal implantation and metachronous carcinogenesis. J Surg Oncol 2016;114(2):228-36. [CrossRef] google scholar
• 9. Phipps AI, Chan AT, Ogino S. Anatomic subsite of primary colorectal cancer and subsequent risk and distribution of second cancers. Cancer 2013;119(17):3140-7. [CrossRef] google scholar
• 10. Raj KP, Taylor TH, Wray C, Stamos MJ, Zell JA. Risk of second primary colorectal cancer among colorectal cancer cases: a population-based analysis. J Carcinog 2011;10:6. [CrossRef] google scholar
• 11. van den Tol PM, van Rossen EE, van Eijck CH, Bonthuis F, Marquet RL, Jeekel H. Reduction of peritoneal trauma by using nonsurgical gauze leads to less implantation metastasis of spilled tumor cells. Ann Surg 1998;227(2):242-8. [CrossRef] google scholar
• 12. Williamson RC, Davies PW, Bristol JB, Wells M. Intestinal adaptation, and experimental carcinogenesis after partial colectomy. Increased tumor yields are confined to the anastomosis. Gut 1982;23(4):316-25. [CrossRef] google scholar
• 13. Costi R, Azzoni C, Marchesi F, Bottarelli L, Violi V, Bordi C. Repeated anastomotic recurrence of colorectal tumors: genetic analysis of two cases. World J Gastroenterol 2011;17(32):3752-8. [CrossRef] google scholar
• 14. Galandiuk S, Wieand HS, Moertel CG, Cha SS, Fitzgibbons RJ Jr, Pemberton JH, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1992;174(1):27-32. google scholar
• 15. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC. Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 2017;41(1):285-94. [CrossRef] google scholar
• 16. Harji DP, Sagar PM, Boyle K, Griffiths B, McArthur DR, Evans M. Surgical resection of recurrent colonic cancer. Br J Surg 2013;100(7):950-8. [CrossRef] google scholar
• 17. Taylor WE, Donohue JH, Gunderson LL, Nelson H, Nagorney DM, Devine RM, et al. The Mayo Clinic experience with multimodality treatment of locally advanced or recurrent colon cancer. Ann Surg Oncol 2002;9(2):177-85. [CrossRef] google scholar
• 18. Wright HK, Thomas WH, Cleveland JC. The low recurrence rate of colonic carcinoma in ileocolic anastomoses. Surg Gynecol Obstet 1969;129(5):960-2. google scholar
• 19. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture. Br J Surg 1984;71(1):12-6. [CrossRef] google scholar
• 20. Jones PF. Anastomotic recurrence of colorectal cancer. Gut 1987;28(12):1691-2. [CrossRef] google scholar
• 21. Matsuda A, Kishi T, Musso G, Matsutani T, Yokoi K, Wang P, et al. The effect of intraoperative rectal washout on local recurrence after rectal cancer surgery: a meta-analysis. Ann Surg Oncol 2013;20(3):856-63. [CrossRef] google scholar
• 22. Pugh SA, Shinkins B, Fuller A, Mellor J, Mant D, Primrose JN. Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Post recurrence Survival: Data From the FACS Randomized Controlled Trial. Ann Surg 2016;263(6):1143-7. [CrossRef] google scholar
• 23. Lee YT. Local and regional recurrence of carcinoma of the colon and rectum: I. Tumour-host factors and adjuvant therapy. Surg Oncol 1995;4(6):283-93. [CrossRef] google scholar
• 24. Liska D, Stocchi L, Karagkounis G, Elagili F, Dietz DW, Kalady MF, et al. Incidence, Patterns, and Predictors of Locoregional Recurrence in Colon Cancer. Ann Surg Oncol 2017;24(4):1093-9. [CrossRef] google scholar
• 25. Read TE, Mutch MG, Chang BW, McNevin MS, Fleshman JW, Birnbaum EH, et al. Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 2002;195(1):33-40. [CrossRef] google scholar
• 26. Weiser MR. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol 2018;25(6):1454-5. [CrossRef] google scholar
• 27. Tsikitis VL, Larson DW, Huebner M, Lohse CM, Thompson PA. Predictors of recurrence free survival for patients with stage II and III colon cancer. BMC Cancer 2014;14:336. [CrossRef] google scholar