Synchronous and “early” metachronous colorectal adenocarcinoma
- 1 August 2000
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 43 (8), 1093-1099
- https://doi.org/10.1007/bf02236556
Abstract
PURPOSE: We evaluated the accuracy of preoperative diagnostic examinations and determined whether patients with synchronous colorectal cancers differ from patients with a single colorectal malignancy in clinicopathologic factors, the possibility of early metachronous colorectal cancer, and postoperative outcome. METHODS: A retrospective evaluation of 1,780 patients with primary colorectal adenocarcinoma from 1987 to 1993 was performed. We divided patients into three groups: Group 1, single colorectal adenocarcinoma; Group 2, synchronous colorectal adenocarcinoma; and Group 3, early metachronous colorectal adenocarcinoma. RESULTS: There were 52 cases (3 percent) in Group 2 and 13 cases (1 percent) in Group 3 (<3 years from the index colorectal cancer operation). Differences in age, gender, and cancer-free rate among the three groups did not reached statistical significance. Compared with cancers in Group 1, significantly more proximal tumor locations and early cancer stage were noted for the second and third cancers in Group 2. In Group 3 a significantly more proximal tumor site was noted for the index colorectal cancer but cancer stage showed no significant difference from cancers in Group 1. Better histologic type was also noted in the index and second cancers in Group 2 than in cancers in Group 1. There was a higher incidence of associated benign adenoma in Group 2 (35 vs. 15 percent in Group 1). The positivity rate of Group 2 was significantly higher by preoperative colonoscopy (71 percent) and incidental findings at surgery (58 percent) than barium enema examination (30 percent). CONCLUSION: Preoperative barium enema examination was an unsatisfactory tool for detecting synchronous tumors. Preoperative colonoscopy demonstrated a higher positivity rate, but it still failed to detect nearly 30 percent of cases with synchronous tumors. Intraoperative palpation of the whole colorectum could detect nearly 60 percent of unexpected synchronous tumors. We believe both colonoscopy and intraoperative palpation of the whole colorectum are crucial to the early detection of synchronous colorectal cancer.Keywords
This publication has 25 references indexed in Scilit:
- Synchronous multiple colorectal adenocarcinomasJournal of Surgical Oncology, 1997
- History of colorectal polypectomy and risk of subsequent colorectal cancerBritish Journal of Surgery, 1987
- Synchronous and ‘early’ metachronous carcinomas of the colon and rectumBritish Journal of Surgery, 1987
- The significance of synchronous carcinoma and polyps in the colon and rectumCancer, 1986
- Incidence of synchronous and metachronous colorectal carcinomaBritish Journal of Surgery, 1984
- Synchronous and metachronous malignancies of the colon and rectum in Japan with special reference to a coexisting early cancerCancer, 1984
- Synchronous primary adenocarcinomas of the colon and rectumDiseases of the Colon & Rectum, 1978
- Multiple carcinomas of the colon and rectumCancer, 1974
- Multiple adenocarcinomas of the colon and rectumDiseases of the Colon & Rectum, 1972
- The lesion of the second cancer of the large bowelBritish Journal of Surgery, 1972