Detection of Resectable Recurrence of Colorectal Cancer Is Not ...

NEW YORK APR 11, 2006 (Reuters Health) - Routine pelvic surveillance by magnetic resonance imaging (MRI) after a curative resection of colorectal cancer is not justified, based on results of a study published in the March issue of the Annals of Surgery.

"Surgical treatment offers the best prospect of survival for patients with recurrent colorectal cancer," Dr. John R. T. Monson, of Castle Hill Hospital, East Yorkshire, UK, and colleague write. "Unfortunately, most cases are often diagnosed at an unresectable stage when traditional follow-up methods are used," they note. "The impact of MRI surveillance on the early diagnosis of local recurrences has yet to be ascertained."

To investigate, the researchers studied 226 patients who underwent curative surgery for rectal and left-sided colon tumors between 1995 and 1999. In addition to the standard follow-up protocol, the patients were included in a program of pelvic surveillance by MRI.

Local recurrence was seen in 30 (13%) of the patients. MRI detected 26 (87%) and missed four (13%) cases. Of the four missed, three were anastomotic recurrences.

Overall, 19 patients (63%) had elevated CEA, and nine (30%) were symptomatic.

"Surgical resection of local recurrent disease was possible in six (20%) cases," Dr. Monson and colleagues explain. "MRI correctly diagnosed four of six (resectable) patients (67%), the same proportion as that diagnosed by conventional follow-up tests."

The researchers therefore suggest that MRI be reserved for investigating patients with "clinical, colonoscopic and/or biochemical suspicion of recurrent disease."

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