Carcinoembryonic antigen levels as an indicator for reoperation in patients with carcinoma of the colon and rectum.

The experience from the University of Minnesota with routine reoperations in cancers classified as Dukes' C suggests only a small minority of patients found to have asymptomatic recurrences will benefit from an additional operation. Also, morbidity and mortality will be significant. The presence of a rising carcinoembryonic antigen level following a potentially curative operation has been suggested as a more selective indicator for reoperation. Unfortunately, carcinoembryonic antigen levels are a far more sensitive indicator of hepatic metastases, the group usually not helped by operation. Patients with local-regional recurrent carcinoma of the colon and rectum--the group most likely to benefit from reoperation--often have normal carcinoembryonic antigen levels. The importance of patient selectivity for reoperation and the usefulness of the Astler-Coller staging system to define risk factors are stressed.