Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1985 Sep;202(3):310–317. doi: 10.1097/00000658-198509000-00006

CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma.

E W Martin Jr, J P Minton, L C Carey
PMCID: PMC1250903  PMID: 4037904

Abstract

Since 1971, serial carcinoembryonic antigen (CEA) levels have been measured to monitor patients after primary resection of colorectal cancer. Based solely on a rise in CEA level above the baseline established after primary resection, 146 patients were readmitted to the hospital. Chest films, liver-spleen scan, colonoscopy, bone scan, abdominal and pelvic CAT scan, and hepatic arteriograms were performed, and elevated CEA levels were confirmed before reexploration was undertaken. In the 146 patients, 139 (95%) had recurrences, and 81 (58%) of these were resectable for potential cure. Two of the first 22 patients re-explored between 1971 and 1975 are still living 11 and 14 years after second look; of 45 patients reoperated upon from 1976 through 1979 and followed for at least 5 years, 14 (31%) are still living. A rise in CEA above the baseline established after primary resection proved to be a sensitive indicator of recurrence and prompted reexploration before symptoms developed. Early alternative therapy was begun in patients with unresectable recurrences.

Full text

PDF
310

Images in this article

311FIG. 1.
on p.311

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armitage N. C., Davidson A., Tsikos D., Wood C. B. A study of the reliability of carcinoembryonic antigen blood levels in following the course of colorectal cancer. Clin Oncol. 1984 Jun;10(2):141–147. [PubMed] [Google Scholar]
  2. Beart R. W., Jr, Metzger P. P., O'Connell M. J., Schutt A. J. Postoperative screening of patients with carcinoma of the colon. Dis Colon Rectum. 1981 Nov-Dec;24(8):585–588. doi: 10.1007/BF02605750. [DOI] [PubMed] [Google Scholar]
  3. Cady B., McDermott W. V. Major hepatic resection for metachronous metastases from colon cancer. Ann Surg. 1985 Feb;201(2):204–209. doi: 10.1097/00000658-198502000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fortner J. G., Silva J. S., Golbey R. B., Cox E. B., Maclean B. J. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984 Mar;199(3):306–316. doi: 10.1097/00000658-198403000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. GOLD P., FREEDMAN S. O. DEMONSTRATION OF TUMOR-SPECIFIC ANTIGENS IN HUMAN COLONIC CARCINOMATA BY IMMUNOLOGICAL TOLERANCE AND ABSORPTION TECHNIQUES. J Exp Med. 1965 Mar 1;121:439–462. doi: 10.1084/jem.121.3.439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gianola F. J., Dwyer A., Jones A. E., Sugarbaker P. H. Prospective studies of laboratory and radiologic tests in the management of colon and rectal cancer patients: I. Selection of useful preoperative tests through an analysis of surgically occult metastases. Dis Colon Rectum. 1984 Dec;27(12):811–818. doi: 10.1007/BF02553945. [DOI] [PubMed] [Google Scholar]
  7. Goslin R., Steele G., Jr, Macintyre J., Mayer R., Sugarbaker P., Cleghorn K., Wilson R., Zamcheck N. The use of preoperative plasma CEA levels for the Stratification of patients after curative resection of colorectal cancers. Ann Surg. 1980 Dec;192(6):747–751. doi: 10.1097/00000658-198012000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hansen H. J., Snyder J. J., Miller E., Vandevoorde J. P., Miller O. N., Hines L. R., Burns J. J. Carcinoembryonic antigen (CEA) assay. A laboratory adjunct in the diagnosis and management of cancer. Hum Pathol. 1974 Mar;5(2):139–147. doi: 10.1016/s0046-8177(74)80061-4. [DOI] [PubMed] [Google Scholar]
  9. Koprowski H. Embryonic precancerous and cancerous human antigens recognized by monoclonal antibodies. Ciba Found Symp. 1983;96:204–229. doi: 10.1002/9780470720776.ch12. [DOI] [PubMed] [Google Scholar]
  10. Mach J. P., Carrel S., Forni M., Ritschard J., Donath A., Alberto P. Tumor localization of radiolabeled antibodies against carcinoembryonic antigen in patients with carcinoma: a critical evaluation. N Engl J Med. 1980 Jul 3;303(1):5–10. doi: 10.1056/NEJM198007033030102. [DOI] [PubMed] [Google Scholar]
  11. Martin E. W., Jr, James K. K., Hurtubise P. E., Catalano P., Minton J. P. The use of CEA as an early indicator for gastrointestinal tumor recurrence and second-look procedures. Cancer. 1977 Feb;39(2):440–446. doi: 10.1002/1097-0142(197702)39:2<440::aid-cncr2820390212>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  12. Martin E. W., Jr, Kibbey W. E., DiVecchia L., Anderson G., Catalano P., Minton J. P. Carcinoembryonic antigen: clinical and historical aspects. Cancer. 1976 Jan;37(1):62–81. doi: 10.1002/1097-0142(197601)37:1<62::aid-cncr2820370110>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  13. Martin E. W., Jr, Kibbey W. E., Minton J. P. Carcinoembryonic antigen (CEA). A new diagnostic tool. Ohio State Med J. 1975 May;71(5):300–302. [PubMed] [Google Scholar]
  14. Martin E., Skivolocki W., Minton J. P. CEA as an adjunct in the diagnosis and prognosis of colorectal carcinoma. Rev Surg. 1975 May-Jun;32(3):214–217. [PubMed] [Google Scholar]
  15. Mavligit G. M., McMurtrey M. J. Role of CEA--a challenge of a verdict. JAMA. 1978 Oct 13;240(16):1714–1715. [PubMed] [Google Scholar]
  16. Minton J. P., Hoehn J. L., Gerber D. M., Horsley J. S., Connolly D. P., Salwan F., Fletcher W. S., Cruz A. B., Jr, Gatchell F. G., Oviedo M. Results of a 400-patient carcinoembryonic antigen second-look colorectal cancer study. Cancer. 1985 Mar 15;55(6):1284–1290. doi: 10.1002/1097-0142(19850315)55:6<1284::aid-cncr2820550622>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  17. Minton J. P., James K. K., Hurtubise P. E., Rinker L., Joyce S., Martin E. W., Jr The use of serial carcinoembryonic antigen determinations to predict recurrence of carcinoma of the colon and the time for a second-look operation. Surg Gynecol Obstet. 1978 Aug;147(2):208–210. [PubMed] [Google Scholar]
  18. Moldofsky P. J., Powe J., Mulhern C. B., Jr, Hammond N., Sears H. F., Gatenby R. A., Steplewski Z., Koprowski H. Metastatic colon carcinoma detected with radiolabeled F(ab')2 monoclonal antibody fragments. Radiology. 1983 Nov;149(2):549–555. doi: 10.1148/radiology.149.2.6622704. [DOI] [PubMed] [Google Scholar]
  19. Savrin R. A., Martin E. W., Jr The relationship of the possible hepatic toxicity of chemotherapeutic drugs and carcinoembryonic antigen elevation. Cancer. 1981 Feb 1;47(3):481–485. doi: 10.1002/1097-0142(19810201)47:3<481::aid-cncr2820470310>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  20. Schlom J., Weeks M. O. Potential clinical utility of monoclonal antibodies in the management of human carcinomas. Important Adv Oncol. 1985:170–192. [PubMed] [Google Scholar]
  21. Staab H. J., Anderer F. A., Hornung A., Stumpf E., Fischer R. Doubling time of circulating cea and its relation to survival of patients with recurrent colorectal cancer. Br J Cancer. 1982 Nov;46(5):773–781. doi: 10.1038/bjc.1982.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Staab H. J., Anderer F. A., Stumpf E., Fischer R. Slope analysis of the postoperative CEA time course and its possible application as an aid in diagnosis of disease progression in gastrointestinal cancer. Am J Surg. 1978 Sep;136(3):322–327. doi: 10.1016/0002-9610(78)90285-4. [DOI] [PubMed] [Google Scholar]
  23. Staab H. J., Anderer F. A., Stumpf E., Hornung A., Fischer R., Kieninger G. Eighty-four potential second-look operations based on sequential carcinoembryonic antigen determinations and clinical investigations in patients with recurrent gastrointestinal cancer. Am J Surg. 1985 Feb;149(2):198–204. doi: 10.1016/s0002-9610(85)80064-7. [DOI] [PubMed] [Google Scholar]
  24. Steele G., Jr, Ellenberg S., Ramming K., O'Connell M., Moertel C., Lessner H., Bruckner H., Horton J., Schein P., Zamcheck N. CEA monitoring among patients in multi-institutional adjuvant G.I. therapy protocols. Ann Surg. 1982 Aug;196(2):162–169. doi: 10.1097/00000658-198208000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Törnqvist A., Ekelund G., Leandoer L. The value of intensive follow-up after curative resection for colorectal carcinoma. Br J Surg. 1982 Dec;69(12):725–728. doi: 10.1002/bjs.1800691213. [DOI] [PubMed] [Google Scholar]
  26. WANGENSTEEN O. H., LEWIS F. J., ARHELGER S. W., MULLER J. J., MACLEAN L. D. An interim report upon the second look procedure for cancer of the stomach, colon, and rectum and for limited intraperitoneal carcinosis. Surg Gynecol Obstet. 1954 Sep;99(3):257–267. [PubMed] [Google Scholar]
  27. WANGENSTEEN O. H., LEWIS F. J., TONGEN L. A. The "second-look" in cancer surgery; a patient with colic cancer and involved lymph nodes negative on the "sixth-look". J Lancet. 1951 Aug;71(8):303–307. [PubMed] [Google Scholar]
  28. Wagner J. S., Adson M. A., Van Heerden J. A., Adson M. H., Ilstrup D. M. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg. 1984 May;199(5):502–508. doi: 10.1097/00000658-198405000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Wanebo J. H., Stearns M., Schwartz M. K. Use of CEA as an indicator of early recurrence and as a guide to a selected second-look procedure in patients with colorectal cancer. Ann Surg. 1978 Oct;188(4):481–493. doi: 10.1097/00000658-197810000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wood C. B., Ratcliffe J. G., Burt R. W., Malcolm A. J., Blumgart L. H. The clinical significance of the pattern of elevated serum carcinoembryonic antigen (CEA) levels in recurrent colorectal cancer. Br J Surg. 1980 Jan;67(1):46–48. doi: 10.1002/bjs.1800670114. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES