Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population

Background: The aim of this study was to determine the incidence and patterns of failure following potentially curative surgery of colonic cancer. Methods: Data were obtained from the cancer registry of the Cote-d'Or (France). Data on 2657 patients who had resection for cure of colonic cancer between 1976 and 2000 were analysed. Local and distant failure rates were calculated using the actuarial method and multivariable analysis was performed using a Cox model. Results: The 5-year cumulative rate was 12.8 per cent for local recurrence and 25.6 per cent for distant metastases. Five-year cumulative local recurrence rates were 4.9 percent for stage I, 11.0 percent for stage II and 23.5 per cent for stage III tumours (P < 0.001). The corresponding rates for distant metastases were 6.4, 21.4 and 48.0 per cent (P < 0.001). The 5-year cumulative rates for distant metastases were 31.7 per cent for the period 1976-1980 and 21.1 per cent for 1996-2000, and the local recurrence rates were 17.6 and 9.0 per cent respectively. The decreases in rates of local recurrence and distant metastases were significant in multivariable analysis. Cancer extension and presenting features were related to patterns of failure. Tumour location was significantly associated with risk of local recurrence, whereas age and gross features were associated with risk of distant metastasis. Conclusion: Recurrence following resection of colonic cancer remains a substantial problem. Follow-up is of particular importance in the 3 years after surgery.