How do you manage local/mesenteric lymph node recurrence of colon cancer after surgery and adjuvant therapy?

The concern is that, as mentioned, that this man has peritoneal recurrences. This would be particularly true if the tumor is mucinous. Chemotherapy trials have not been abundant in patients with peritoneal metastases, and suggestions are that they are not as sensitive to chemotherapy.

My recommendations are complete staging as best you can to get a better idea of the intraabdominal disease, and if the peritoneal disease can be documented, proceed to a cytoreductive surgery in the hopes of CC1/CC0 resection.

Regarding hyperthermic therapy, I am so far unimpressed by any benefit. If there is, it must be small after all these years and the selection of patients. The morbidity of this procedure and even mortality is considerable, and I would th...

Management of oligometastic colorectal cancer is a frequently encountered clinical problem. The success of local therapy for liver metastases has been well studied, with survival rates as high as 25% at 10 years for this population (Kanas GP, et al, 2012). The value of this approach has been extrapolated to patients with low-volume lung disease as well. How this data translates to patients with oligometastatic disease to mesentery or abdominal lymph nodes is less clear. There are several reasons an aggressive approach may not be as beneficial.

1) CT imaging often under represents the extent of mesenteric/peritoneal involvement and so isolated disease is less common

2) patients with oligometastatic nodal disease are likely to have microscopic...

What was time frame? Early or late relapse? Was a PET and/or MRI abd done to confirm no other sites of disease? If positive, then unresectable and treatment is palliative and would do chemo (if rapid recurrence would be inclined to switch to FOLFIRI assuming adjuvant was FOLFOX and not just 5-FU) + biologic (bevacizumab or cetuximab depending on all RAS status). Also, check MMR/MSI since he may be a candidate for pembrolizumab.

I agree with the crux of the responses.

Local only recurrences in colorectal cancer are rare but tend to be associated with poor prognosis. For this reason, starting with chemotherapy makes sense with the potential to pursue additional surgery if disease remains limited over time with further investigations.

Would you consider SBRT or radiotherapy for consolidation (instead of surgery) if only partial response to chemotherapy and PET CT does not show any other site of disease except local site?