Synchronous Colorectal Tumors—Conclusions Regarding Incidence, Localization, Staging, Treatment, and Survival Rates
DOI:
https://doi.org/10.14748/8sfcs430Keywords:
synchronous colorectal tumors, surgery, cancerAbstract
Introduction: Every surgeon encounters at least once in his or her practice synchronous colorectal tumors (SCRTs), benign and malignant. Questions about their characteristics arise.
Aim: The aim of this study is to present our conclusions regarding incidence, localization, staging, treatment, and survival rates of the encountered SCRTs (benign and malignant).
Materials and Methods: This paper is a retrospective analysis of 80 SCRTs, diagnosed and treated in the First and Second Surgical Departments and Gastroenterology of Princess Clementine General Hospital for the 2017–2021 period.
According to the histopathology, the studied 80 SCRTs fell into the following categories: SCRTs—19 patients; polyps associated with colorectal (CR) cancers—12 patients; synchronous colorectal polyps—49 patients.
Colonoscopies were performed in the First Surgical Department by a surgeon. The following parameters were assessed: number of SCRTs per patient; localization; histopathology; TNM stage of malignant ones. The performed procedures were endoscopic and/or surgery.
Results: The majority of the patients were in the 61–70 age group.
Due to controversial results we could not associate SCRT with gender.
The distribution according to the number of SCRT per patient was as follows: 2 tumors—55; 3 tumors—10; 4 tumors—10; 5–10 tumors—5 patients.
The SCRTs in both the group of cancers and that of cancers and polyps, mostly had left-sided localization.
The SCRTs were mostly localized in one segment or in close segments.
In 90–95% of the cases, SCRTs were adenocarcinomas.
Synchronous CR polyps were mostly hyperplastic polyp and tubular adenoma, usually of the same histopathology.
Detailed staging of cancers was present.
In most of synchronous CR cancers the grading was the same—Grade2.
In regard to localization of the operations for synchronous CR cancers, the majority of the cases had one radical bowel resection.
For synchronous CR cancers and polyps, combined methods were used—surgery and endoscopy, in order to remove the cancers and the polyps, or extended resection.
For polyps the performed procedures were as follows: biopsy—5; biopsy and endoscopic polypectomy—12; surgery and endoscopic polypectomy—10; surgery—18 cases.
The survival rates of the synchronous CR cancer group and the group of synchronous CR cancers and polyps were higher than the ones in the solitary cancer group: – respectively 3-year survival—68%, 58%, and 52%, respectively; 5-year survival—63%, 58%, and 46%, respectively.
In-hospital mortality of the synchronous CR cancers group was lower than the one in the solitary cancers group.
Discussion: The diagnostic and treatment strategies for SCRTs comprised:
- Total colonoscopy was performed in all cases.
- If synchronous polyps were found to be small and not suitable for removal, biopsy of every tumor was performed and the patient was included in follow-up.
- Pediculated polyps were removed during colonoscopy. If this was not possible, they were subjected to open surgery, such as laparotomy, colotomy, polypectomy, and suture.
- When synchronous benign and malignant tumors were found, the possibilities were:
- Removal of the benign ones during colonoscopy and surgery for the malignant to follow.
- Removal of one of the benign ones during colonoscopy and surgery for the malignant and the remaining benign (if close) to follow.
Conclusion: Since multiple SCRTs exist at the same time, it is necessary for all tumors to be diagnosed simultaneously
The aim is to have no missed tumors
If preoperative colonoscopy is not able to inspect the entire colon, it is necessary to have an intraoperative one.
Intraoperative colonoscopy designs the final plan for treatment of each one of the SCRTs.
One radical bowel resection is the most frequently performed operation for SCRTs.
Radical bowel resection and polypectomy are the most frequently performed procedures for SCRTs and polyps.
There are controversial results from different authors and series.
References
[1] Lam AKY, Chan SSY, Leung M. Synchronous colorectal cancer: Clinical, pathological and molecular implications. World JGastroenterol 2014; 20(22): 6815-6820
[2] Welch JP. Multiple colorectal tumors. An appraisal of natural history and therapeutic options. Am J Surg. 1981 Aug;142(2):274-80. doi: 10.1016/0002-9610(81)90292-0.
[3] Kim MS, Park YJ. Detection and treatment of synchronous lesions in colorectal cancer: the clinical implication of perioperative colonoscopy. World J Gastroenterol. 2007 Aug 14;13(30):4108-11. doi: 10.3748/wjg.v13.i30.4108.
[4] Neugut AI, Lautenbach E, Abi-Rached B, Forde KA. Incidence of adenomas after curative resection for colorectal cancer. Am J Gastroenterol 1996; 91: 2096-2098
[5] Howard ML, Greene FL. The effect of preoperative endoscopy on recurrence and survival following surgery for colorectal carcinoma. Am Surg. 1990 Mar;56(3):124-7.
[6] Kaibara N, Koga S, Jinnai D. Synchronous and metachronous malignancies of the colon and rectum in Japan with special reference to a coexisting early cancer. Cancer. 1984 Nov 1;54(9):1870-4. doi: 10.1002/1097-0142(19841101)54:9<1870::aid-cncr2820540917>3.0.co;2-5.
[7] Cunliffe WJ, Hasleton PS, Tweedle DE, et al. Incidence of synchronous and metachronous colorectal carcinoma. Br J Surg. 1984 Dec;71(12):941-3. doi: 10.1002/bjs.1800711210.
[8] Langevin JM, Nivatvongs S. The true incidence of synchronous cancer of the large bowel. A prospective study. Am J Surg. 1984 Mar;147(3):330-3. doi: 10.1016/0002-9610(84)90161-2.
[9] Greenstein AJ, Slater G, Heimann TM, et al. A comparison of multiple synchronous colorectal cancer in ulcerative colitis, familial polyposis coli, and de novo cancer. Ann Surg. 1986 Feb;203(2):123-8. doi: 10.1097/00000658-198602000-00002.
[10] Finan PJ, Ritchie JK, Hawley PR. Synchronous and 'early' metachronous carcinomas of the colon and rectum. Br J Surg. 1987 Oct;74(10):945-7. doi: 10.1002/bjs.1800741021.
[11] Wagner HE, Barbier PA, Luder PJ, et al. Prognosis in synchronous colorectal carcinomas. Z Gastroenterol. 1988 Feb;26(2):117-20.
[12] Evers BM, Mullins RJ, Matthews TH, Broghamer WL, Polk HC Jr. Multiple adenocarcinomas of the colon and rectum. An analysis of incidences and current trends. Dis Colon Rectum. 1988 Jul;31(7):518-22. doi: 10.1007/BF02553724.
[13] Adloff M, Arnaud JP, Bergamaschi R, et al. Synchronous carcinoma of the colon and rectum: prognostic and therapeutic implications. Am J Surg. 1989 Mar;157(3):299-302. doi: 10.1016/0002-9610(89)90555-2.
[14] Fegiz G, Ramacciato G, Indinnimeo M, et al. Synchronous large bowel cancer: a series of 47 cases. Ital J Surg Sci. 1989;19(1):23-8.
[15] Greig JD, Miller DF. Synchronous and early metachronous carcinomas of the colon and rectum. Acta Chir Scand. 1989 Apr-May;155(4-5):287-9.
[16] Eu KW, Seow-Choen F, Goh HS. Synchronous colorectal cancer in an Oriental population. Int J Colorectal Dis. 1993 Dec;8(4):193-6. doi: 10.1007/BF00290304.
[17] Kimura T, Iwagaki H, Fuchimoto S, et al. Synchronous colorectal carcinomas. Hepatogastroenterology. 1994 Oct;41(5):409-12.
[18] Hayakumo T, Cho E, Nakajima M, et al. Point mutations in the c-K-ras 2 gene in multiple colorectal carcinomas. J Gastroenterol Hepatol. 1995 Jan-Feb;10(1):70-5. doi: 10.1111/j.1440-1746.1995.tb01051.x.
[19] Passman MA, Pommier RF, Vetto JT. Synchronous colon primaries have the same prognosis as solitary colon cancers. Dis Colon Rectum. 1996 Mar;39(3):329-34. doi: 10.1007/BF02049477.
[20] Koness RJ, King TC, Schechter S, et al. Synchronous colon carcinomas: molecular-genetic evidence for multicentricity. Ann Surg Oncol. 1996 Mar;3(2):136-43. doi: 10.1007/BF02305792.
[21] Takeuchi H, Toda T, Nagasaki S, et al. Synchronous multiple colorectal adenocarcinomas. J Surg Oncol. 1997 Apr;64(4):304-7. doi: 10.1002/(sici)1096-9098(199704)64:4<304::aid-jso10>3.0.co;2-2.
[22] Bekdash B, Harris S, Broughton CI, et al. Outcome after multiple colorectal tumours. Br J Surg. 1997 Oct;84(10):1442-4.
[23] Eguchi K, Yao T, Konomoto T, et al. Discordance of p53 mutations of synchronous colorectal carcinomas. Mod Pathol. 2000 Feb;13(2):131-9. doi: 10.1038/modpathol.3880024.
[24] Chen HS, Sheen-Chen SM. Synchronous and "early" metachronous colorectal adenocarcinoma: analysis of prognosis and current trends. Dis Colon Rectum. 2000 Aug;43(8):1093-9. doi: 10.1007/BF02236556.
[25] Chirila DN, Popp RA, Balacescu O, et al. GST gene variants in synchronous colorectal cancers and synchronous association of colorectal cancers with other cancers. Chirurgia (Bucur). 2013 May-Jun;108(3):365-71.
[26] Norrie MW, Hawkins NJ, Todd AV, et al. The role of hMLH1 methylation in the development of synchronous sporadic colorectal carcinomas. Dis Colon Rectum. 2002 May;45(5):674-80. doi: 10.1007/s10350-004-6266-1.
[27] Oya M, Takahashi S, Okuyama T, et al. Synchronous colorectal carcinoma: clinico-pathological features and prognosis. Jpn J Clin Oncol. 2003 Jan;33(1):38-43. doi: 10.1093/jjco/hyg010.
[28] Ueno M, Muto T, Oya M, et al. Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer. Int J Clin Oncol. 2003 Jun;8(3):162-7. doi: 10.1007/s10147-003-0322-z.
[29] Dykes SL, Qui H, Rothenberger DA, et al. Evidence of a preferred molecular pathway in patients with synchronous colorectal cancer. Cancer. 2003 Jul 1;98(1):48-54. doi: 10.1002/cncr.11445.
[30] Wang HZ, Huang XF, Wang Y, et al. Clinical features, diagnosis, treatment and prognosis of multiple primary colorectal carcinoma. World J Gastroenterol. 2004 Jul 15;10(14):2136-9. doi: 10.3748/wjg.v10.i14.2136.
[31] Nikoloudis N, Saliangas K, Economou A, et al. Synchronous colorectal cancer. Tech Coloproctol. 2004 Nov;8 Suppl 1:s177-9. doi: 10.1007/s10151-004-0149-2.
[32] Papadopoulos V, Michalopoulos A, Basdanis G, et al. Synchronous and metachronous colorectal carcinoma. Tech Coloproctol. 2004 Nov;8 Suppl 1:s97-s100. doi: 10.1007/s10151-004-0124-y.
[33] Latournerie M, Jooste V, Cottet V, et al. Epidemiology and prognosis of synchronous colorectal cancers. Br J Surg. 2008 Dec;95(12):1528-33. doi: 10.1002/bjs.6382.
[34] Tziris N, Dokmetzioglou J, Giannoulis K, et al. Synchronous and metachronous adenocarcinomas of the large intestine. Hippokratia. 2008 Jul;12(3):150-2.
[35] Yalcinkaya U, Ozturk E, Ozgur T, et al. P53 expression in synchronous colorectal cancer. Saudi Med J. 2008 Jun;29(6):826-31.
[36] Nosho K, Kure S, Irahara N, et al. A prospective cohort study shows unique epigenetic, genetic, and prognostic features of synchronous colorectal cancers. Gastroenterology. 2009 Nov;137(5):1609-20.e1-3. doi: 10.1053/j.gastro.2009.08.002.
[37] Lam AK, Carmichael R, Gertraud Buettner P, et al. Clinicopathological significance of synchronous carcinoma in colorectal cancer. Am J Surg. 2011 Jul;202(1):39-44. doi: 10.1016/j.amjsurg.2010.05.012.
[38] Mulder SA, Kranse R, Damhuis RA, et al. Prevalence and prognosis of synchronous colorectal cancer: a Dutch population-based study. Cancer Epidemiol. 2011 Oct;35(5):442-7. doi: 10.1016/j.canep.2010.12.007.
[39] Derwinger K, Gustavsson B. A study of aspects on gender and prognosis in synchronous colorectal cancer. Clin Med Insights Oncol. 2011;5:259-64. doi: 10.4137/CMO.S7871.
[40] Hu H, Chang DT, Nikiforova MN, et al. Clinicopathologic features of synchronous colorectal carcinoma: A distinct subset arising from multiple sessile serrated adenomas and associated with high levels of microsatellite instability and favorable prognosis. Am J Surg Pathol. 2013 Nov;37(11):1660-70. doi: 10.1097/PAS.0b013e31829623b8.
[41] Şavlovschi C, Comandaşu M, Şerban D. Specifics of diagnosis and treatment in synchronous colorectal cancers (SCC). Chirurgia (Bucur). 2013 Jan-Feb;108(1):43-5.
[42] Ueda E, Watanabe T, Umetani N, et al. Microsatellite instability of cancers and concomitant adenomas in synchronous multiple colorectal cancer patients. J Exp Clin Cancer Res. 2002 Jun;21(2):149-54.
[43] Ikeda Y, Saku M, Kawanaka H, et al. Distribution of synchronous and metachronous multiple colorectal cancers. Hepatogastroenterology. 2004 Mar-Apr;51(56):443-6.
[44] Fukatsu H, Kato J, Nasu JI, et al. Clinical characteristics of synchronous colorectal cancer are different according to tumour location. Dig Liver Dis. 2007 Jan;39(1):40-6. doi: 10.1016/j.dld.2006.07.015.
[45] Petrov B, Zarkov K, Petkov Chr. Synchronous colorectal tumors - tactics for diagnostics and treatment. Literature review and own studies. Surgery 2018; 2: 52-71.
[46] Lam AK, Gopalan V, Carmichael R, et al. Metachronous carcinomas in colorectum and its clinicopathological significance. Int J Colorectal Dis. 2012 Oct;27(10):1303-10. doi: 10.1007/s00384-012-1474-y.
[47] Chu DZ, Giacco G, Martin RG, et al. The significance of synchronous carcinoma and polyps in the colon and rectum. Cancer. 1986 Feb 1;57(3):445-50. doi: 10.1002/1097-0142(19860201)57:3<445::aid-cncr2820570307>3.0.co;2-d.
