Consensus and controversies regarding follow‐up after treatment with curative intent of nonmetastatic colorectal cancer: a synopsis of guidelines used in countries represented in the European Society of Coloproctology

Abstract

Aim It is common clinical practice to follow patients for a period of years after treatment with curative intent of nonmetastatic colorectal cancer, but follow‐up strategies vary widely. The aim of this systematic review was to provide an overview of recommendations on this topic in guidelines from member countries of the European Society of Coloproctology, with supporting evidence. Method A systematic search of Medline, Embase and the guideline databases Trip database, BMJ Best Practice and Guidelines International Network was performed. Quality assessment included use of the AGREE‐II tool. All topics with recommendations from included guidelines were identified and categorized. For each subtopic, a conclusion was made followed by the degree of consensus and the highest level of evidence. Results Twenty‐one guidelines were included. The majority recommended that structured follow‐up should be offered, except for patients in whom treatment of recurrence would be inappropriate. It was generally agreed that clinical visits, measurement of carcinoembryoinc antigen and liver imaging should be part of follow‐up, based on a high level of evidence, although the frequency is controversial. There was also consensus on imaging of the chest and pelvis in rectal cancer, as well as endoscopy, based on lower levels of evidence and with a level of intensity that was contradictory. Conclusion In available guidelines, multimodal follow‐up after treatment with curative intent of colorectal cancer is widely recommended, but the exact content and intensity are highly controversial. International agreement on the optimal follow‐up schedule is unlikely to be achieved on current evidence, and further research should refocus on individualized ‘patient‐driven’ follow‐up and new biomarkers.

Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

“…Despite the little existing agreement between different European guidelines, most recommend clinical visits, CEA monitoring and liver imaging as part of follow-up [12]. This survey's results showed a heterogeneous practice of national guidelines, but CEA was used as a diagnostic tool by all respondents either every 3 months or 6 months in the first 2 years.…”

“…The Dutch guidelines do not mention the value of DRE during follow-up. However, it is recommended in other European countries and local protocols [12].…”

“…A recent review of European guidelines conducted by Bastiaenen et al demonstrated that although multimodal follow-up after curative treatment of CRC is recommended in all countries, the precise content and intervals of these modalities are variable [12]. The Dutch national guidelines for CRC have similarities with the European Society for Medical Oncology (ESMO) and American Society of Clinical Oncology-American Society of Colon and Rectal Surgeons (ASCO-ASCRS) guidelines.…”

Low rate of local recurrence detection by rectoscopy in follow‐up of rectal cancer

“…In the present surveillance protocol, rectoscopy is not effective. Future studies should also address the ability of rectoscopy to detect local recurrence .…”

Differences in baseline characteristics and 1-year psychological factors between participants and non-participants in the randomized, controlled trial regarding patient-led follow-up after rectal cancer (FURCA)

“…Following this, the number of RC survivors has increased substantially, of whom many experience late effects and impaired quality of life (QoL) [3][4][5]. Traditional follow-up programs following RC show great variance internationally, and the evidence is low [6]. In general, the focus is on early detection and treatment of recurrent disease and metachronous cancers [6].…”