A prospective randomized study of follow-up after radical surgery for colorectal cancer

Kjeldsen, B. J.; Kronborg, O; Fenger, Claus; Jørgensen, Ole Dan

doi:10.1046/j.1365-2168.1997.02733.x

Cited by 153 publications

(176 citation statements)

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“…There were six randomised controlled trials (Makela et al, 1995;Ohlsson et al, 1995;Kjeldsen et al, 1997;Pietra et al, 1998;Schoemaker et al, 1998;Secco et al, 2002) comprising 1679 participants, 858 assigned to intensive and 821 assigned to conventional followup (webappendix1). The surveillance tests, and the frequency of their use, varied considerably (webappendix2).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…Two trials (Pietra et al, 1998;Schoemaker et al, 1998) reported allocation by open cards or random number tables. Randomisation was stratified by site and Dukes' stage in two trials (Kjeldsen et al, 1997;Schoemaker et al, 1998). Specifically, with relation to this analysis, blinding of clinicians and/or assessors about interpretation of recurrence detection and/or decisions about subsequent treatments were not mentioned, except for one trial (Schoemaker et al, 1998).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…Overall lives gained Makela et al (1995) Ohlsson et al (1995) Kjeldsen et al (1997) Schoemaker et al ( Figure 1 Absolute risk differences for overall lives gained, lives gained through salvage and through factors other than salvage: random-effects method. CI: confidence interval.…”

Section: Absolute Risk Difference (95% Ci) % Weightmentioning

confidence: 99%

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Mechanisms of improved survival from intensive followup in colorectal cancer: a hypothesis

et al. 2005

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A meta-analysis of six randomised trials demonstrated that intensive followup in colorectal cancer was associated with an absolute reduction in all-cause 5-year mortality of 10% (95% confidence interval (CI): 4 -16) -however, only two percent (95% CI: 0 -5) was attributable to cure from salvage re-operations. We postulate that other factors, such as increased psychological well-being and/or altered lifestyle, and/or improved treatment of coincidental disease may contribute to the remaining lives saved, and form important future research questions. Approximately two-thirds of patients presenting with colorectal cancer undergo resection with curative intent, and most subsequently enter protocols for long-term followup (Kievit, 2002). The rationale for surveillance is three-fold: psychological support, facilitation of audit, and an opportunity for the early detection and treatment of recurrent disease, with potential improvement in survival. Recently, the authors (Renehan et al, 2002b) reported a meta-analysis of five randomised trials and demonstrated a significant improvement in all-cause 5-year mortality in patients followed intensively. A Cochrane review (Jeffery et al, 2002) independently found similar results, and, subsequently, a sixth randomised trial reported additional results supporting these conclusions (Secco et al, 2002). These data offer the first direct evidence that intensive followup improves survival, but fall short of evaluating the mechanisms underlying the observed survival benefit. This study updates and extends our previous metaanalysis to explore the survival mechanisms associated with intensive followup. MATERIALS AND METHODSThe search strategy, inclusion and exclusion criteria, data extraction, and study quality assessment have been published elsewhere (Renehan et al, 2002b(Renehan et al, , 2004, with further details at www.christie.man.ac.uk/profinfo/departments/surgery/default. htm. The key features were:Updated search strategy (to December 2003) using Cochrane methodology.Inclusion criteria were: randomised controlled trial; patients with colorectal cancer treated surgically with curative intent; randomisation at or shortly after surgery, and availability of 5-year survival data. Data were extracted independently by two investigators (AGR, MPS). Important components of methodological quality, namely adequacy of concealment of patients' allocation to treatment groups, double-blinding, and withdrawals, were assessed. Statistical analysisMeta-analyses were performed at two levels. First, comparisons of events (e.g. all-cause deaths) for intensive vs conventional followup were performed and pooled estimates expressed as risk ratios (RR) and 95% confidence intervals (95% CIs). Second, estimates of the proportion of overall lives gained, and lives gained through to salvage re-operation, were calculated using absolute risk differences (and 95% CIs) (Deeks and Altman, 2001). The difference between these estimates was taken as an estimate of the gain in lives attributable to nonsalvage-related ...

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Section: Baseline Characteristicsmentioning

confidence: 99%

Section: Baseline Characteristicsmentioning

confidence: 99%

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Mechanisms of improved survival from intensive followup in colorectal cancer: a hypothesis

et al. 2005

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“…[6][7][8][9][10][11][12] These studies compared surveillance in two groups of patients that had colon or rectal cancer resection. All seven trials had two types of surveillance groups: a high intensity and a low intensity (control) group.…”

Section: Is Follow-up Justified?mentioning

confidence: 99%

“…Only 1.7 to 7% of all the symptomatic patients have resectable disease. 3,8,18 Therefore, intensive follow-up should aim to identify patients with recurrent disease in the asymptomatic group. Routine follow-up, can ensures that adequate surveillance, provide reassurance, counselling (advice screening for family members) and provide psychological support to the patient.…”

Section: Follow-up Intervalsmentioning

confidence: 99%

Surveillance and Survivorship after Treatment for Colon Cancer

Makhoul

Alva

Wilkins

2015

Clinics in Colon and Rectal Surgery

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Colorectal cancer is the third most common cancer diagnosed in the United States. Majority of patients have localized disease that is amenable to curative resection. Disease recurrence remains a major concern after resection. In addition, patients are at an increased risk for developing a second or metachronous colon cancer. The principal goal of surveillance following treatment of colon cancer is to improve disease-free and overall survival. Survivorship is a distinct phase following surveillance to help improve quality of life and promote longevity.

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Intensive Risk-Adjusted Follow-up With the CEA, TPA, CA19.9, and CA72.4 Tumor Marker Panel and Abdominal Ultrasonography to Diagnose Operable Colorectal Cancer Recurrences

Nicolini

Ferrari²,

Duffy³

et al. 2010

Arch Surg

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A prospective randomized study of follow-up after radical surgery for colorectal cancer

Abstract: Patients subjected to intensive follow-up have recurrence diagnosed earlier, and have more operations for recurrence, but the survival results suggest that any major improvement by intensive follow-up is unlikely.

Cited by 153 publications

References 16 publications

Mechanisms of improved survival from intensive followup in colorectal cancer: a hypothesis

Mechanisms of improved survival from intensive followup in colorectal cancer: a hypothesis

Surveillance and Survivorship after Treatment for Colon Cancer

Intensive Risk-Adjusted Follow-up With the CEA, TPA, CA19.9, and CA72.4 Tumor Marker Panel and Abdominal Ultrasonography to Diagnose Operable Colorectal Cancer Recurrences

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