대한대장항문학회

Purpose : Recurrent disease after curative surgery for primary colorectal cancer is well-<br>known problem. Recurred colorectal cancer, even hepatic metastasis, can be operable in case<br>of non-systemic metastasis. In those cases, a favorable prognosis is expected. But,<br>regrettably in most cases which showed recurrence after curative surgery poor prognosis was<br>remained. Methods : In our hospital, we have experienced 98 patients with recurred colorectal<br>cancer among 607 patients who had curative operation from Jan. 1980 to Feb. 1998. We<br>analyzed retrospectively those patients and considered factors which influenced recurrence of<br>disease and prognosis (type of recurrence, age, sex, location of tumor, histology of tumor, size<br>of tumor, depth of tumor invasion, lymph node involvement, tumor stage, DNA ploidy pattern,<br>serum CEA level, oncogene expression of tumor and reoperation). Results : 1) The Mean of<br>disease-free interval after curative operation was 15.9 months (range: 3.0∼44.5 months). 2)<br>Among total patients with recurrence, patients with local recurrence were 29 cases (29.6%),<br>those with liver metastasis were 29 cases (29.6%), lung metastasis were 7 cases (7.1%), lung<br>and liver metastasis were 7 cases (7.1%), peritoneal metastasis were 18 cases (18.4%), lymph<br>node metastasis were 7 cases (7.1%), brain metastasis was 1 case (1.0%). 3) The curative<br>reoperation was performed in 19 patients (19.4%). Those procedures were abdominoperineal<br>resection (4), local perineal resection (6), hepatic resection (2), Hartmann's procedure (2),<br>segmental resection of ileum (2), Whipple's operation (1), resection of ileal pouch in patient<br>with FAP (1), oophorectomy (1). 4) Those factors which influenced recurrence were tumor<br>stage, histologic type of tumor, depth of tumor invasion, lymph node status, preoperative<br>serum CEA level. 5) The mean survival time of patients with recurred colorectal cancer was<br>25.1 months. The 36 months survival rate of patients with recurred colorectal cancer among<br>various sites of recurrence was different significantly (p=0.04). Those patients with local<br>recurrence showed most favorable prognosis (42.0% in 36 months survival rate) and those<br>with liver metastasis showed worst prognosis (4.7%). 6) The 36 months survival rate of<br>reoperative group was 54.3% and that of non-operative group was 20.5 months. The result of<br>two groups was statistically different (p＜0.001). Conclusions : We concluded that those<br>factors which influenced recurrence in colorectal cancer were tumor stage, histologic type,<br>invasion depth, lymph node status, and preoperative serum CEA level. Also the survival rate<br>of reoperative group was higher than that of non-operative group statistically.<br>