Local and regional recurrence of carcinoma of the colon and rectum: I. Tumour-host factors and adjuvant therapy.

A review of 13 studies (published from 1976 to 1991) shows that the mean loco-regional recurrence rate after resection of colorectal carcinoma is 17%, and nearly one-third of these had only a loco-regional relapse. Approximately half of the pelvic recurrences of rectal cancer appeared within 1 year, and half of the colonic loco-regional recurrences within 2 years. Among 5336 patients studied, there was a progressively higher loco-regional recurrence rate with increased pathological stages: the medians were 2%, 7%, 19%, 21% and 32%, respectively, for Dukes A, B1, B2, C1 and C2 lesions. Other significant prognostic factors include the age of the patient, site of the primary tumour, mucinous subtype, degree of differentiation and vascular or lymphatic invasion. For resected rectal cancers, adjuvant radiotherapy has decreased loco-regional recurrence by 20-30%, especially when it is given preoperatively and/or with added systemic chemotherapy. These quantitative loco-regional recurrence data were collected before systemic adjuvant chemotherapy and radiotherapy were popularized, and before laparoscopic minimal invasive surgery was widely practiced. Thus, they are a useful baseline of information to study the changes in rates and types of relapse in the future.