Our Experiences of Tertiary Referral Centers in the Management of Recurrent Colonic Cancer after an Initial Curative Right-sided Colonic Resection
Authors: Toor Asad A. , Higgins Lynne , Haq Asif , Haji Amyn , Nunoo-Mensah Joseph W. 
Published: October 2023

Abstract

Background:
Colon cancer is one of the most common types of cancer. Oncological surgical resection is the most effective method to achieve a successful outcome, but the prognosis of recurrence is poor.

Objectives:
The objective of our study was to provide an insight into our management of patients who have experienced recurrences by first assessing the 5-year survival rate of patients who underwent curative surgery for right-sided colon cancer and then reporting on the rate and management of recurrences.

Study Design:
We conducted a retrospective study using a prospective database of patients with recurrent colon cancer following an initial curative right-sided resection.

Setting:
In the study, patients diagnosed and treated at King’s College Hospital for colorectal cancer between 2011 and 2015 were included.

Patients and Methods:
The study included patients with right-sided colonic adenocarcinoma (including the cecum, ascending colon, hepatic flexure, and proximal two-thirds of the transverse colon) who had undergone curative surgical resection and had completed follow-up.

Main Outcome Measures:
Our main outcome measures were survival after curative resection of right-sided colon cancers, recurrence, and survival after recurrence.

Sample Size:
Our study included 195 patients.

Results:
In this study, 195 patients with stages I–III right-sided colonic tumors were treated with primary curative surgical resection (R0), of which 173 (86.7%) were treated electively and 22 (11.3%) were treated as an emergency. A total of 104 men (53.3%) and 91 women (46.7%) participated in our study, and the mean age at diagnosis was 69.2 (12.8) years. After a 5-year follow-up period, 145 patients (74.4%) successfully completed the follow-up with no loss of patients. We noted that 88.7% of the patients had no recurrence, but 22 (11.3%) of 195 patients experienced recurrences and 28 (14.4%) died. Following further analysis of the patients with recurrences, we found that 13 (6.6%) had distant metastases, seven (3.5%) had local recurrences, and two (1.2%) had multiple recurrences. The mean time to recurrence was 15.1 (10.8) months. Recurrence was associated with a mean survival rate of 39.64 (19.2) months compared to 53.9 ± 15.1 for patients without recurrence (Log Rank P = 0.000). Among patients with recurrences, the 5-year survival rate was 31.8%; however, it was 80.9% (Log Rank P = 0.000) for those without recurrences. Patients with recurrent cancer who received curative treatment had a 5-year survival rate of 40.0% compared to 14.3% for those who received palliative treatments (Log Rank P = 0.068).

Conclusion:
In our study, right-sided colorectal cancer after oncological surgical resection was associated with a recurrence rate of 11.3%. The survival rate was inversely proportional to the stage of the disease at the time of diagnosis. Detection of recurrence and surgical intervention in a timely manner are associated with improved survival rates.

Limitations:
This study has limitations, including its retrospective nature. We collected data for this study from electronic records and databases of patients after completion of follow-up.

Conflict of Interest:
The authors have no conflict of interest to declare.