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Kang, Choi, Lim, Park, and Jun: Risk Factors of Peritoneal Recurrence after Curative Resection of Colorectal Cancer
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(5): 355-361.

Published online: 12 November 2010

DOI: https://doi.org/10.4174/jkss.2010.79.5.355

Risk Factors of Peritoneal Recurrence after Curative Resection of Colorectal Cancer

Byung Mo Kang, M.D., Gyu Seog Choi, M.D., Kyoung Hoon Lim, M.D., In Ja Park, M.D., Soo Han Jun, M.D.

Division of Colorectal Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

Corresponding author (kyuschoi@mail.knu.ac.kr)

Received 30 June 2010       Accepted 19 August 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Peritoneal recurrence after curative resection of colorectal cancer has been considered to be a lethal condition and to be suitable for palliative chemotherapy. Recently, aggressive approaches such as cytoreductive surgery and perioperative intraperitoneal chemotherapy were introduced for peritoneal malignancies to improve survival. The aim of this study is to identify the risk factors of peritoneal recurrence after curative resection of colorectal cancer and to determine the indication of early postoperative intraperitoneal chemotherapy (EPIC).

Methods

From January 1997 to December 2007, a total of 2,320 patients' records with curative resection for colorectal cancer were collected through the prospective colorectal cancer registry protocol in Kyungpook National University Hospital, Korea. Of those, a total of 1,929 patients were included for analysis of the relationship between perioperative clinicopathologic variables and peritoneal recurrence.

Results

The study group was composed of 1,086 men and 843 women with a mean age of 61.1. In multivariate analysis, preoperative level of serum CA19-9>37 U/ml (odd ratio [OR] 3.217; 95% confidence interval [95% CI] 1.525~6.788), right colon cancer (OR 2.524; 95% CI 1.158~5.502), pT4 tumor (OR 2.131; 95% CI 1.009~4.502) and positive apical lymph node (OR 3.045; 95% CI 1.023~9.066) were independent risk factors of peritoneal recurrence after curative resection of colorectal cancer.

Conclusion

In colorectal cancer patients with increased preoperative serum levels of CA19-9, right-sided location, serosal exposure or invasion of adjacent organ, and positive apical lymph node, more scrupulous surveillance for peritoneal recurrence was necessary during the postoperative follow-up period. In selective patients with risk factors of peritoneal recurrence, more aggressive strategies for management, such as EPIC, were able to be considered under the acceptable general condition and life-expectancy.

Keywords: Peritoneal recurrence, Risk factors, Colorectal cancer, Intraperitoneal chemotherapy

Figures and Tables

Table 1
Clinicopathologic characteristics (n=1,929)
jkss-79-355-i001

*BMI = body mass index; †CEA = carcinoembryonic antigen; ‡CA = carbohydrate antigen; §CT = computed tomography; ∥PET = positron emission tomography.

Table 2
Univariate analysis for the risk factors of peritoneal recurrence
jkss-79-355-i002

*CEA = carcinoembryonic antigen; †CA = carbohydrate antigen.

Table 3
Multivariate logistic regression analysis for risk factors of peritoneal recurrence
jkss-79-355-i003

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