Is frequent measurement of tumor markers beneficial for postoperative surveillance of colorectal cancer?

PURPOSE: To determine whether frequent measurement of tumor markers triggers early detection of colorectal cancer recurrence. METHODS: Of 1,651 consecutive patients undergoing colorectal cancer surgery between 2010 and 2016, 1,050 were included. CEA and CA 19-9 were considered to be postoperative tumor markers and were measured every 3 months for 3 years, and then every 6 months for 2 years. Sensitivity analysis of elevated CEA and CA19-9 levels and multivariate analysis of factors associated with elevated CEA and CA19-9 levels were performed. The proportion of triggers for detecting recurrence was determined. RESULTS: The median follow-up period was 5.3 years. After applying the exclusion criteria, 1,050 patients were analyzed, 176 (16.8%) of whom were found to have recurrence. After excluding patients with persistently elevated CEA and CA19-9 levels before and after surgery from the 176 patients, 71 (43.6%) of 163 patients had elevated CEA levels and 35 (20.2%) of 173 patients had elevated CA19-9 levels. Sensitivity/positive predictive values for elevated CEA and CA19-9 levels at recurrence were 43.6%/32.3% and 20.2%/32.4%, respectively. Lymph node metastasis was a factor associated with both elevated CEA and CA19-9 levels at recurrence. Of the 176 patients, computed tomography triggered the detection of recurrence in 137 (78%) and elevated tumor marker levels in 13 (7%); the diagnostic lead interval in the latter 13 patients was 1.7 months. CONCLUSION: Tumor marker measurements in surveillance after radical colorectal cancer resection contribute little to early detection, and frequent measurements are unnecessary for stage I patients with low risk of recurrence.

Feasibility of Endo GIA™ Reinforced Reload with Tri-Staple™ Technology for delta-shaped anastomosis.

BACKGROUND: We report the short-term clinical outcomes of a delta-shaped (DS) anastomosis in laparoscopic distal gastrectomy (LDG), comparing Endo GIA™ Reinforced Reload (Reinforced GIA) with Endo GIA™ (GIA) staplers. METHODS: This was a retrospective analysis of 40 patients who underwent totally LDG with DS anastomosis with Reinforced GIA (group A) and 90 patients who underwent the same procedure with GIA (group B) for clinical T1-T3 gastric cancer from May 2013 to December 2016. Operation time, intraoperative blood loss, hospital length of stay, reconstruction time, and complications were compared. RESULTS: No patients required conversion to open surgery, and no patients died. There was no significant difference between the groups regarding patient background, postoperative hospital stay, and operation time. Bleeding from the V-shaped anastomosis was significantly less frequent in group A compared with group B (0% vs 11.2%, p = 0.021). Anastomosis-related complications were less frequent in group A, but there was no statistically significant difference between the groups. The fasting period in group A was significantly shorter than that of group B (2.81 vs 3.39 days, p = 0.034). CONCLUSION: DS anastomosis using Reinforced GIA can prevent minor postoperative anastomosis leakage. Based on our findings and experience, we recommend DS anastomosis with Reinforced GIA after LDG for gastric cancer as an effective procedure with good short-term outcomes.