PATTERNS OF RECURRENCE AND TREATMENT FOLLOWING RIGHT HEMICOLECTOMY FOR ADENOCARCINOMA
Francisco J. Cardenas Lara*1, Fabian Grass2, Eric Dozois2, David W. Larson2, Kellie L. Mathis2
1General Surgery, Mayo Clinic, Rochester, MN; 2Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
Background:Previous studies have shown a decrease in overall survival rates in patients with right-sided colon cancer as well as a higher incidence of distant recurrence compared to patients with left-sided colon cancer. Recurrence rates of up to 13% have been reported.
Objective: We aimed to determine the incidence, patterns, and treatment of recurrence in a large cohort of patients treated with a standard right hemicolectomy for colon adenocarcinoma at a single institution.
Methods: We performed a retrospective study including patients who developed a recurrence following a curative intent right hemicolectomy for stage I-III colon cancer between 1995 and 2015. Patients with stage IV disease, original surgery performed at another institution and a prior history of colorectal cancer were excluded. Local recurrence was classified as tumor within the original operative site (anastomosis, abdominal wall, port sites, mesentery). Regional recurrence was defined as lymphatic disease within the retroperitoneum as well as peritoneal disease (diffuse and localized). Distant disease was classified as solid organ metastasis.
Results: A total of 1654 right hemicolectomies for stage I-III colon cancer were performed at our institution over the 20 year time frame. Patients were followed for a median of 5.1 years (IQR 2.6, 8.4). A total of 124 patients (7.5%) presented with any recurrence (Table 1) at a median time of 3.1 years (IQR 1.5, 6.2). In the 124 patients with recurrence, patterns of recurrence were local in 30 patients (24%), regional in 50 patients (40%), and distant in 52 patients (42%). Seventeen patients (14%) had multiple sites of recurrence, and 6 patients had metachronous colon tumors. Sixty-three patients (51%) underwent curative intent treatment for the recurrence and the remainder had palliative treatment or no treatment (Table 2). In patients treated with curative intent for recurrence (n=63), disease free survival was at 81%, 54% and 43% at 1, 3, and 5 years. Overall survival in the entire group (n=124) was 54%, 38% and 28% at 1,3, and 5 years and was 81%, 61%, and 47% at 1, 3, and 5 years in those treated with a curative intent (n=63).
Conclusion: We found a low rate of recurrence following a right hemicolectomy for stage I-III colon adenocarcinoma. Distant recurrence was most common. When identified early, curative treatment is possible with good long-term outcomes.
Table 1: Location and Incidence of Recurrence
| Location of Recurrence | N | N (% of all right hemicolectomies n=1654) |
| Local recurrence | 30 | 1.8% |
| Regional recurrence | 50 | 3.0% |
| Distant recurrence | 52 | 3.1% |
| Multiple sites | 17 | 1.0% |
| Metachronous colon cancer only | 6 | 0.4% |
Table 2: Treatment of Recurrence
| Treatment modality | N (%) | % curative intent |
| None | 27 (22%) | 0 |
| Surgery/HIPEC alone | 29 (23%) | 79 |
| Chemotherapy alone | 28 (23%) | 34 |
| Radiation alone | 7 (6%) | 14 |
| Surgery plus chemotherapy | 27 (22%) | 85 |
| Chemoradiation | 3 (2%) | 67 |
| Surgery, chemotherapy, radiation | 3 (2%) | 100 |
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