Anastomotic recurrence of carcinoma of the colon and rectum. The value of endoscopy and serum CEA levels
Himal, H.S.
American Surgeon 57(5): 334-337
1991
ISSN/ISBN: 0003-1348 PMID: 2039134 Document Number: 370012
The early diagnosis of anastomotic recurrence after surgery for carcinoma of the colon and rectum is difficult. Whether repeat colonoscopy and serial serum CEA measurements were useful in diagnosing early anastomotic recurrence was examined. A total of 112 patients with carcinoma of the colon and rectum who had undergone resection and anastomosis were followed with frequent colonoscopy and serum CEA measurements. Seventeen patients developed anastomotic recurrence. Fourteen patients had elevated serum CEA levels, and 15 patients had endoscopic evidence suggesting recurrence at the anastomotic site. CT scans of the abdomen and pelvis demonstrated metastatic disease in seven patients, localized anastomotic disease in six patients, and no evidence of disease in four patients. Laparotomy was then carried out in 10 patients. In eight of 10 patients, it was possible to resect localized disease. In a 3-year follow-up study, eight patients were alive, four without any evidence of recurrent disease. Repeat colonoscopy and serum CEA measurements are recommended as postoperative surveillance for carcinoma of the colon and rectum. In select cases laparotomy and resection may prolong survival.