Predictive factors affecting on anastomotic reccurrence of resectable colon cancer

OBJECTIVE: Colorectal carcinoma is the most common malignancy of the gastrointestinal tract. There are many idintified risk factors such as age, aging, male gender, hereditery risc factors, inflamatory bowel diseases, enviromental and dietary factors. Patients who have been treated for one colorectal cancer are at risk for the development of recurrent disease (either locally or systemically) or metachronous disease (a second primary tumor). Most recurrences occur within 2 years of the original diagnosis. Althoug the margins of the specimen are negative and the oncologic surgery is performed, anastomotic reccurence can occur. The aim of this study, to find the predictive factors which can be determinent on anastomotic reccurence. PATIENTS AND METHODS: A total number of 160 patients were included who underwent colon cancer resection between 1st of January 2008 and 31th of December 2018. 25 of them were operated for reccurent disease and the other 130 patients were choosen for whom had no locally or metastatic reccurent disease at least 2 years after surgery. Tumour localisation is categorized as right colon, transverse colon, left colon and sigmoid colon. Data on patient demographics, tumour location, type of surgery, histologic grade, anastomotic technic, number of dissected lenf node, number of metastatic lenf node, TNM stage according to the AJCC 8th edition, tumour margins, tumour size, proximal and distal distance from tumour location, presence of anjiolymphatic invasion, presence of venous invasion, presence of tumour budding, presence of perineural invasion, negative specimen margins and survival without reccurrence were collected. RESULTS: A total of 160 patients met the inclusion criteria, and their outcomes further analyzed. The median age was 61 years, 64(%40) were female and 96(%60) were male. The median time to reccurrence was 21.3 months. Factor associated with a statistically significant increase in anastomotic reccurrence rate on univariable analysis included tumour type, differentiation, T stage, anastomotic technic, number of metastatic lenf node, tumour margins, presence of tumour budding and presence of perineural invasion. Factors associated with indipendent factors with an increased reccurence at anastomosis rate were the anastomosises made by hand technique (OR 45,532 ,%95 CI: 5,278-392,778), T stage (OR 3,593 ,%95 CI: 1,378-9,371) and presence of tumoral budding (OR 3,912 ,%95 CI: 1,306-11,715). Survival without reccurence according to T stage was statistically significant (p=0,006; p<0,01). The survival without reccurence for T4 stage determined patients were lower than T1,T2 and T3 stage patients. Adjuvant chemotherapy did not correlate with anastomotic reccurrence. CONCLUSIONS: Local reccurence is a major problem with severe impact on survival and morbidity. Lymph node metastasis and adjuvant chemotherapy have significant importance for metastatic disease, but they don't have predictive value for anastomotic recurrence. T stage and histopatological features are predictive factors for anastomotic recurrence.