Practice Parameters for the Surveillance and Follow-Up of Patients With Colon and Rectal Cancer

Abstract

The American Society of Colon and Rectal Surgeons is dedicated to assuring high quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather that dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Gastrointestinal cancer and brain metastasis

“…Current guidelines regarding systemic surveillance after surgery for CRC are controversial with respect to the need for routine chest and liver imaging. 49,50 Nonetheless, all patients diagnosed with systemic metastasis, particularly patients with pulmonary involvement, should undergo neuroimaging for early detection of subclinical intracranial metastasis. 47 Routine imaging of the brain for staging purposes in patients with no evidence of metastatic disease is neither beneficial nor cost-effective regardless of the site of the primary tumor.…”

Patient–Clinician Information Engagement Improves Adherence to Colorectal Cancer Surveillance after Curative Treatment: Results from a Longitudinal Study

“…Routine postoperative surveillance represents an integral part of the follow-up care of patients diagnosed with colorectal cancer (CRC) who undergo potentially curative resection [1][2][3]. Cancer surveillance is aimed at detecting recurrences of the cancer amenable to further curative treatment, screening for new tumors or polyps, and detecting metastatic sites before patients present with symptoms.…”

Surveillance and Survivorship after Treatment for Colon Cancer

“…Despite the fact that we do not have data to recommend tests or frequency of visits, one can draw conclusions based on some facts. 1 Recurrence is most common in the first 2 to 3 years after surgery. One metaanalysis, 16 that included nonrandomized trials, suggested better results with follow-up every 4 months during the first 2 years.…”

“…25,26 Several studies showed that a postoperative CEA level > 5 ng/mL has a positive predictive value of 70 to 80% of recurrent disease. 1 An elevated CEA level is one of the first indicators of recurrent disease (38-66%). It is a very cost-effective test in colorectal cancer surveillance.…”

“…1,2 Each year approximately 148,000 new cases of colon and rectal cancer are diagnosed in the United States. Surgical resection remains the definitive primary therapy and approximately 70 to 80% of these patients have cancers that are resected with curative intent.…”