Analysis of treatment and prognosis of synchronous multiple primary colorectal cancer: a report of 39 cases

Abstract

Objective: To analyse the incidence, diagnosis and treatment effect of multiple synchronous primary co-lorectal carcinoma(SCRC) to both explore reasonable alternative treatment types and improve the recognition of SCRC. Methods: The clinical data of 39 cases with SCRC admitted to Department of Surgery, Ruijin Hospital from December 2012 to June 2018 were retrospectively. Diagnosis and surgical types with postoperative survival was analysed. Results: There were 39 cases with SCRC, 27 cases male and 12 cases female, accounting for 2.84% of the cases with colorectal cancer in same period. The age (59.46±1.80) years in this study was lower than that of cases with single colorectal cancer in that period (P<0.001). Preoperative diagnosis rate of the cases with SCRC was 45.95% using colonoscopy and 21.21% using CT. Two cases with SCRC were diagnosed preoperatively by PET-CT examination and found all the focuses. In all cases, 20 cases with lesions located in same intestinal segment underwent standard radical resection of colorectal cancer. Extended radical colorectal resection was done for 3 cases. For the other 16 cases with distant lesions, 10 cases underwent segmental radical resection, and 6 cases total or subtotal colorectal resection, which had the longest operative time(P=0.008). There was no difference in intraoperative blood loss of cases (P>0.05) and in hospital stay (P>0.05) among different surgery. The most number of lymph nodes dissected was the cases using segmental resection and total or subtotal resection (P=0.004) and the cases with total or subtotal resection had the most number of defecation per day(P<0.001). The 3-year survival rate of cases with standard radical surgery of colorectal cancer was 100.00%, and the 5-year survival rate 83.33%. For the cases with segmented resection and subtotal or total colorectal resection, the 3-year survival rate was 60.00%, and the 5-year survival rate 44.44%. Conclusions: The incidence of SCRC might be low and would to be missed the diagnosis more. Endoscopy combined with enhanced CT or PET-CT favored the preoperative diagnosis. Standard radical resection of colorectal cancer was done for the lesions in same intestinal segment with better prognosis. The lesions located separately in the segment and far apart had poorer prognosis.

Keywords

• |multiple synchronous primary colorectal carcinoma|endoscopy|radical resection