Outcome of Follow-Up Programs in Patients Previously Resected for Colorectal Cancer

Abstract

The survival of a group of 115 patients (group A) who entered a follow-up program after apparently "curative" surgery for colorectal cancer was compared with that of 62 similar patients (group B) who did not join such a program. No significant difference was found. Clinical benefits to single patients in group A, in terms of anticipated diagnosis and effective treatment of recurrences and of metachronous neoplasias, appeared to be, if any, extremely limited. In light of the high costs of intensive follow-up programs, it is concluded that their use can be justified only within controlled perspective trials aimed to evaluate their usefulness.

Follow-up after Colorectal Cancer Surgery

“…There are higher 5-year survival rates in the groups with intensive follow-up compared with the controls, median 70% and 60%, respectively, with one exception, the Dukes' B group in the study by Pugliese et al (24). If the randomized studies only are considered, the difference will be 73% versus 60%.…”

“…It was concluded that more recurrences could be resected for cure among patients undergoing intensive follow-up compared with no or minimal follow-up. There was also a 9.1% (95% CI, '/2.2 to'/16.0%) higher 5-year survival rate favouring intensive follow-up, but only when CEA was included in the follow-up programme, which was the case in three studies (11,23,24). These three studies also included liver imaging.…”

“…A large number of studies concerning follow-up after resection for colorectal cancer have been published, but most of them are non-randomized single cohort studies, and only a few are prospective randomized studies (7,16,18,25,26,94) or comparative cohort studies (11,15,17,24,91,93) (Table 3). The control groups in all the cohort studies are patients that partly or totally have refused to participate in the follow-up programme.…”

“…Liver imaging (ultrasonography or computed tomography (CT)) was not included in two of the studies (7,16). Serum carcinoembryonic antigen (CEA) was included in all but two studies (16,24), but it should be noted that in the study by Schoemaker et al (94), an isolated increase in CEA levels was not used to trigger further investigations.…”

“…Furthermore, the patient groups are heterogeneous; for instance, stratification for low-risk and high-risk groups is made in only two studies (24,26), rectal cancer patients are not distinguished from colon cancer patients and it is unclear to what extent adjuvant chemotherapy or radiotherapy is given.…”