Intensive Follow-Up After Curative Surgery for Colorectal Cancer

Detalhes bibliográficos
Autor(a) principal: Rodrigues, Rita Vale
Data de Publicação: 2017
Outros Autores: Silva, João Pereira da, Rosa, Isadora, Santos, Isabel, Pereira, Nuno, Soares, Carla, Pereira, António Dias
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889
Resumo: Introduction: The purpose of postoperative surveillance programs after curative treatment for colorectal cancer is to detect asymptomatic recurrences with the premise that an important rate will be eligible for curative resection, improving overall survival. We have implemented a surveillance program for patients with colorectal cancer, stages II-III, with periodic clinical, carcinoembryonic antigen and cancer antigen-19-9 assessment, computed tomography and colonoscopy. The aim of this study was to assess the rate of curative treatment of recurrence, colorectal cancer mortality and clinical characteristics associated with non-resectable recurrence.Material and Methods: Open cohort study, single center. All patients on the intensive surveillance program between March 2008 and January 2015 were included. Statistics: chi-square, Wilcoxon rank sum test, logistic regression, Kaplan-Meier log-rank test (SPSS20®).Results: We had a total 404 patients evaluated; 59.6% male; mean age of 65 ± 10 years; 50.7% rectal tumor; 56.2% stage III. The average time of follow-up was 37 months and the recurrence rate was 12.9% (n = 52), mostly detected in the first three years (88.4%). The pattern of recurrence was associated with the site of the primary tumor (p < 0.001). Twenty-one patients underwent curative resection. Factors associated with non-resectable recurrence were aged ≥ 70 years (p = 0.022), disease location in the colon (p = 0.033) and cancer antigen-19-9-9 elevation (p = 0.024). The overall rate of cancer-specific mortality was 2.2% (n = 9).Discussion: The association between colon cancer and non-resectable recurrence is explained by the higher rate of disseminated disease in these patients. Cancer antigen-19-9 added no benefit to the surveillance program.Conclusion: This intensive real-world postoperative surveillance program allowed performing curative surgery to 40.3% of patients with recurrence.
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spelling Intensive Follow-Up After Curative Surgery for Colorectal CancerVigilância Intensiva do Carcinoma Colo-Rectal após Tratamento de Intenção CurativacContinuity of Patient CareColorectal Neoplasms/surgeryFollow-Up StudiesSurvival AnalysisAnálise de SobrevidaContinuidade de Cuidados ao DoenteNeoplasias Colorrectais/cirurgiaSeguimentoIntroduction: The purpose of postoperative surveillance programs after curative treatment for colorectal cancer is to detect asymptomatic recurrences with the premise that an important rate will be eligible for curative resection, improving overall survival. We have implemented a surveillance program for patients with colorectal cancer, stages II-III, with periodic clinical, carcinoembryonic antigen and cancer antigen-19-9 assessment, computed tomography and colonoscopy. The aim of this study was to assess the rate of curative treatment of recurrence, colorectal cancer mortality and clinical characteristics associated with non-resectable recurrence.Material and Methods: Open cohort study, single center. All patients on the intensive surveillance program between March 2008 and January 2015 were included. Statistics: chi-square, Wilcoxon rank sum test, logistic regression, Kaplan-Meier log-rank test (SPSS20®).Results: We had a total 404 patients evaluated; 59.6% male; mean age of 65 ± 10 years; 50.7% rectal tumor; 56.2% stage III. The average time of follow-up was 37 months and the recurrence rate was 12.9% (n = 52), mostly detected in the first three years (88.4%). The pattern of recurrence was associated with the site of the primary tumor (p < 0.001). Twenty-one patients underwent curative resection. Factors associated with non-resectable recurrence were aged ≥ 70 years (p = 0.022), disease location in the colon (p = 0.033) and cancer antigen-19-9-9 elevation (p = 0.024). The overall rate of cancer-specific mortality was 2.2% (n = 9).Discussion: The association between colon cancer and non-resectable recurrence is explained by the higher rate of disseminated disease in these patients. Cancer antigen-19-9 added no benefit to the surveillance program.Conclusion: This intensive real-world postoperative surveillance program allowed performing curative surgery to 40.3% of patients with recurrence.Introdução: A vigilância intensiva pós-operatória do carcinoma colo-retal permite a deteção da recorrência em fase assintomática, aumentando o número de doentes que podem beneficiar de nova cirurgia. Implementámos um programa de vigilância de doentes com carcinoma colo-retal estádios II-III, operados com intenção curativa, com avaliação clínica, tomografia computorizada e colonoscopia. O presente estudo teve como objectivos avaliar a taxa de cirurgia de intenção curativa, a taxa de mortalidade por cancro e identificar características clínicas associadas à irresecabilidade da recidiva.Material e Métodos: Estudo de coorte, unicêntrico. Foram incluídos todos os doentes com carcinoma colo-retal integrados em programa de vigilância entre março de 2008 e janeiro de 2015. Análise estatística: qui-quadrado, Wilcoxon, regressão logística, Kaplan-Meier (SPSS20®).Resultados: Avaliámos 404 doentes; idade média: 65 ± 10 anos, 59,6% sexo masculino, 50,7% reto, 56,2% estádio III. O tempo médio de vigilância foi 37 meses e a taxa de recidiva foi 12,9% (n = 52), a maioria detetada nos primeiros três anos (88,4%). O padrão de recidiva associou-se à localização do tumor primário (p < 0,001). Vinte e um doentes foram submetidos a cirurgia curativa. Os fatores associados a recidiva irressecável foram: idade ≥ 70 anos (p = 0,022), carcinoma colo-retal localizado no cólon (p = 0,033) e elevação de antigénio carboidrato 19-9 (p = 0,024). A taxa global de mortalidade específica por cancro foi 2,2% (n = 9).Discussão: A associação entre neoplasia do cólon e recidiva irressecável deve-se à taxa mais elevada de doença disseminada nestes doentes. O antigénio carboidrato 19-9 não trouxe benefício acrescido ao programa de vigilância.Conclusão: Este estudo confirma o interesse clínico da vigilância intensiva na deteção de recidiva assintomática, permitindo alcançar cirurgia curativa em 40,3% dos doentes com recidiva.Ordem dos Médicos2017-09-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfimage/jpegapplication/mswordapplication/mswordapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889oai:ojs.www.actamedicaportuguesa.com:article/7889Acta Médica Portuguesa; Vol. 30 No. 9 (2017): September; 633-641Acta Médica Portuguesa; Vol. 30 N.º 9 (2017): Setembro; 633-6411646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/5152https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/8522https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/9229https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/9480https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/9562Direitos de Autor (c) 2017 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessRodrigues, Rita ValeSilva, João Pereira daRosa, IsadoraSantos, IsabelPereira, NunoSoares, CarlaPereira, António Dias2022-12-20T11:05:20Zoai:ojs.www.actamedicaportuguesa.com:article/7889Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:30.809119Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Intensive Follow-Up After Curative Surgery for Colorectal Cancer
Vigilância Intensiva do Carcinoma Colo-Rectal após Tratamento de Intenção Curativa
title Intensive Follow-Up After Curative Surgery for Colorectal Cancer
spellingShingle Intensive Follow-Up After Curative Surgery for Colorectal Cancer
Rodrigues, Rita Vale
cContinuity of Patient Care
Colorectal Neoplasms/surgery
Follow-Up Studies
Survival Analysis
Análise de Sobrevida
Continuidade de Cuidados ao Doente
Neoplasias Colorrectais/cirurgia
Seguimento
title_short Intensive Follow-Up After Curative Surgery for Colorectal Cancer
title_full Intensive Follow-Up After Curative Surgery for Colorectal Cancer
title_fullStr Intensive Follow-Up After Curative Surgery for Colorectal Cancer
title_full_unstemmed Intensive Follow-Up After Curative Surgery for Colorectal Cancer
title_sort Intensive Follow-Up After Curative Surgery for Colorectal Cancer
author Rodrigues, Rita Vale
author_facet Rodrigues, Rita Vale
Silva, João Pereira da
Rosa, Isadora
Santos, Isabel
Pereira, Nuno
Soares, Carla
Pereira, António Dias
author_role author
author2 Silva, João Pereira da
Rosa, Isadora
Santos, Isabel
Pereira, Nuno
Soares, Carla
Pereira, António Dias
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv Rodrigues, Rita Vale
Silva, João Pereira da
Rosa, Isadora
Santos, Isabel
Pereira, Nuno
Soares, Carla
Pereira, António Dias
dc.subject.por.fl_str_mv cContinuity of Patient Care
Colorectal Neoplasms/surgery
Follow-Up Studies
Survival Analysis
Análise de Sobrevida
Continuidade de Cuidados ao Doente
Neoplasias Colorrectais/cirurgia
Seguimento
topic cContinuity of Patient Care
Colorectal Neoplasms/surgery
Follow-Up Studies
Survival Analysis
Análise de Sobrevida
Continuidade de Cuidados ao Doente
Neoplasias Colorrectais/cirurgia
Seguimento
description Introduction: The purpose of postoperative surveillance programs after curative treatment for colorectal cancer is to detect asymptomatic recurrences with the premise that an important rate will be eligible for curative resection, improving overall survival. We have implemented a surveillance program for patients with colorectal cancer, stages II-III, with periodic clinical, carcinoembryonic antigen and cancer antigen-19-9 assessment, computed tomography and colonoscopy. The aim of this study was to assess the rate of curative treatment of recurrence, colorectal cancer mortality and clinical characteristics associated with non-resectable recurrence.Material and Methods: Open cohort study, single center. All patients on the intensive surveillance program between March 2008 and January 2015 were included. Statistics: chi-square, Wilcoxon rank sum test, logistic regression, Kaplan-Meier log-rank test (SPSS20®).Results: We had a total 404 patients evaluated; 59.6% male; mean age of 65 ± 10 years; 50.7% rectal tumor; 56.2% stage III. The average time of follow-up was 37 months and the recurrence rate was 12.9% (n = 52), mostly detected in the first three years (88.4%). The pattern of recurrence was associated with the site of the primary tumor (p < 0.001). Twenty-one patients underwent curative resection. Factors associated with non-resectable recurrence were aged ≥ 70 years (p = 0.022), disease location in the colon (p = 0.033) and cancer antigen-19-9-9 elevation (p = 0.024). The overall rate of cancer-specific mortality was 2.2% (n = 9).Discussion: The association between colon cancer and non-resectable recurrence is explained by the higher rate of disseminated disease in these patients. Cancer antigen-19-9 added no benefit to the surveillance program.Conclusion: This intensive real-world postoperative surveillance program allowed performing curative surgery to 40.3% of patients with recurrence.
publishDate 2017
dc.date.none.fl_str_mv 2017-09-29
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dc.relation.none.fl_str_mv https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/5152
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/8522
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/9229
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/9480
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7889/9562
dc.rights.driver.fl_str_mv Direitos de Autor (c) 2017 Acta Médica Portuguesa
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dc.publisher.none.fl_str_mv Ordem dos Médicos
publisher.none.fl_str_mv Ordem dos Médicos
dc.source.none.fl_str_mv Acta Médica Portuguesa; Vol. 30 No. 9 (2017): September; 633-641
Acta Médica Portuguesa; Vol. 30 N.º 9 (2017): Setembro; 633-641
1646-0758
0870-399X
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