Feasibility and Outcomes of Salvage Therapy for Recurrence in Colorectal Cancer Patients Followed Up with a...

Treatment for colorectal cancer has improved significantly over the last few decades. The feasibility of treating colorectal cancer recurrence is also increasing. The surveillance protocol applied influences the pattern of diagnosis of recurrence. Adherence to intense follow up protocols may be challenged by limitation of resource, pointing to the scope of forming tailored strategies. The objectives were to determine the rate of salvage, disease-free and overall survival, the types of local therapy applied, morbidity associated with radical local treatment, and the factors influencing survival of patients followed up using a low intensity regimen after curative treatment for recurrent colorectal cancer. We included patients diagnosed with colorectal cancer recurrence from January 2010 to December 2016 at the institute. The clinicopathological and treatment details were collected. Treatment outcomes were analyzed and compared with the baseline characteristics. Of 109 recurrences, 26 (23.8%) were offered curative therapy. Locoregional treatment modalities consisted of four cases of pelvic exenteration (18.2%), four (18.2%) resections of peritoneal deposits including two (9.1%) multivisceral resections, four (18.2%) hepatic resections, two (9.1%) lung metastasectomies, one (4.5%) retroperitoneal lymph node dissection, and two (4.5%) ablative procedures. Four (18.2%) and one (4.5%) cases received chemoradiotherapy and systemic therapy alone. Surgical resection had 6.2% Clavien-Dindo grade III, 25% grade II, and 25% grade I morbidities. With a median follow-up of 95 months, the median DFS and OS were 48 months and 55 months for curatively treated patients. The rate of curative therapy was low in a low-intensity follow-up regimen (23.8%). Yet, curative treatment including complex resections offers a survival advantage with acceptable morbidity rates, in select patients with limited disease affecting a single region.