Patterns of tumour recurrence after luminal tumour resection

Abstract

•. Locoregional recurrence following resection of luminal tumours is common. •. Recurrence in upper gastrointenstinal tumours often occurs within the first year post surgery. •. There is little evidence to support a particular imaging surveillance protocol. •. Patients often present with clinical symptoms secondary to recurrent disease. •. CT is predominantly the imaging modality of choice given wide availability. •. MRI is more sensitive in evaluation of the pelvis. •. Other modalities of imaging, particularly fluoro-2-deoxy-d-glucose positron emission tomography/CT, are a useful adjunct. The tissues that make up the gut lumen from the oesophagus to the rectum give rise to a variety of tumours that differ widely in biological behaviour, as well as outcome, following surgical resection. The features that determine the resectability of upper gastrointestinal tract (GIT) tumours differ from those for tumours of small bowel origin and those tumours found more distally within the colon or rectum. Tumour recurrence can be defined as locoregional or distant, and patterns of recurrence are dependent on both the site of the primary lesion and underlying histopathological tumour type. Locoregional recurrence can occur at the resection site and within local draining vessels or lymphatics. Distant recurrence patterns for GIT tumours are also site dependent, but the issues and strategies regarding imaging are similar for all sites. Although multiple imaging modalities are utilised to follow up resected GIT tumours, the most commonly used modality is CT, with concurrent use of positron emission tomography/CT and MRI where appropriate. In this review, the commonly observed patterns of tumour recurrence are described for different epithelial primary tumour sites, as well as the optimal modalities for detecting such recurrence and outlining the extent of disease. In addition, some of the clinical implications of such recurrence are explored.