Colorectal Follow-Up Planning Modified on the Basis of Our Personal Experience

Abstract

Background: The authors, evaluating the disappointing follow-up results in patients suffering from colorectal carcinoma who had undergone surgery for cure, tried a more rational follow-up. Methods: In a retrospective review about 232 patients who adhered to the follow-up protocol, we evaluated the accuracy rates of CEA, liver ultrasonography and abdominal CT. In the same group of patients, we evaluated the type of correlation between the neoplastic recurrence rate and Astler-Coller’s classification. Results: (1) In detecting hepatic metastases CEA levels furnished sensitivity and negative predictive value more than liver ultrasonography (83.3 vs. 77.8% and 98.4 vs. 98%, respectively); (2) in our series, we obtained a lower recurrence rate in classes A+B1 (7.5%) and B2 (20.8%) and higher in C1+C2 (44.4%) and D (66.7%) (p < 0.01). Conclusion: According to these data we decided to eliminate postoperative liver ultrasonography and customize follow-up protocol on tumor staging and timing of cancer relapse. The authors believe that these changes will not modify the results, but cause less psychophysical stress for the patients and reduce costs by 50%.

Is Routine Magnetic Resonance Imaging Justified for the Early Detection of Resectable Liver Metastases From Colorectal Cancer?

“…An earlier study comparing the efficacy of liver ultrasound vs. CEA monitoring in detecting hepatic recurrences showed that CEA measurement appeared to have a better sensitivity and negative predictive value, although the difference was not statistically significant. 18 This coupled with the finding that recurrences were more likely in patients with C1, C2, and D tumors in the Astler-Coller classification determined the authors to renounce routine liver ultrasonography and customize their follow-up protocol on primary tumor staging. Our own results seem to support the concept that liver imaging is better reserved for patients found to have abnormal clinical signs and/or biochemical parameters, and the act that patients with early-stage cancers (AstlerColler A and B1) have a greatly reduced risk of developing liver recurrences compared with those with more advanced tumors (P = 0.002, Pearson chisquared test).…”

Biliary carcinoembryonic antigen in the diagnosis of occult hepatic metastases from colorectal cancer

“…The results concerning the validity of CEA determination for early diagnosis of postoperative hepatic metastases have already been published [6,9]. Sensitivity, positive prognostic value (PPV) and diagnostic accuracy (DA) of biliary CEA in detecting hepatic metastases were determined in the entire study cohort.…”

Management of colorectal cancers

“…There is some evidence to suggest that CT scanning as part of a routine follow up programme may be useful. [110][111][112][113][114][115] One randomised controlled trial found that follow up is efficient and cost effective if patients at higher risk are followed up more intensively than those at lower risk. 116 Patients at greatest risk are those with more advanced tumours at the time of resection-particularly stage III cancers.…”