Clinical and pathologic evaluation of patients with recurrence of colorectal cancer five or more years after curative resection

PURPOSE: This study was designed to evaluate the characteristics of recurrences that occur five or more years after curative resection for colorectal cancer. METHODS: This study included a total of 352 patients who were confirmed as having recurrence after curative resection for colorectal cancer during the period from January 1995 to December 2000. Of the 352 patients, 231 had early recurrence (less than 2 years after operation), 103 had intermediate recurrence (2-5 years after operation), and 18 had late recurrence (more than 5 years after operation). The clinicopathologic findings of the patients with late recurrence were compared with those of the other two recurrence groups, with special reference to the pattern of recurrence. RESULTS: The rate of late recurrence was 1.2 percent. In the late recurrence group, males outnumbered females by a ratio of 3.5:1 and the mean level of preoperative carcinoembryonic antigen was 4.5 ng/ml, whereas that of the early recurrence group was 30.5 ng/ml. All the lesions in the cases with late recurrence except one lesion were located in the left colon or rectum, the tumors were small-sized and polypoid, and well-differentiated adenocarcinomas were more frequently observed. Distant metastasis, especially lung metastasis, was most frequently observed. CONCLUSIONS: Late recurrent colorectal cancer has some characteristics compared with early or intermediate recurrence. Although recurrence at more than five years postoperatively is not common, its possibility should be considered whenever performing follow-up, and surveillance for lung metastasis is recommended after more than five years of surgery.