Adenocarcinoma of the colon: an autopsy study with implications for new therapeutic strategies.

Clinical, pathologic, and autopsy records of 53 patients who had localized adenocarcinoma of the proximal colon and had undergone potentially curative surgery were analyzed to define ultimate patterns of recurrence and final patterns of dissemination. Ten patients (19%) died with locoregional recurrence alone (operative bed and retroperitoneal nodes). Liver metastases were present in 31 patients, accompanied by other sites of infradiaphragmatic failure in 29 patients (94%). Twenty-three patients (43%) died with cancer confined to the abdomen, retroperitoneum, and liver. The distribution of involved sites points to potential refinements in the surgical staging of this cancer and suggests a rational strategy for planning adjuvant therapy designed to address all the principal early mechanisms of disease dissemination.