Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Follow-up of colorectal cancer

A meta-analysis


PURPOSE: The value of intensive follow-up for patients after resection of colorectal cancer remains controversial. This study reviews all randomized and prospective cohort studies to assess the value of aggressive follow-up. METHODS: The literature was searched from the years 1972 to 1996 for studies reporting on the follow-up of patients with colorectal cancer. Randomized and comparative-cohort studies that included history, physical examination, and carcinoembrionic antigen values at least three times a year for at least two years were included in a meta-analysis. Single-cohort studies with intensive follow-up and traditional follow-up were also included in a two-group comparative analysis for each outcome indicator. Outcome indicators were 1) curative resection rates after recurrent cancer, 2) survival rates of curative re-resections, 3) length of survival after recurrence, and 4) cumulative five-year survival. RESULTS: Two randomized and three comparative-cohort studies met these criteria and included 2,005 patients, which were evaluated in the meta-analysis. The cumulative five-year survival was 1.16 times higher in the intensively followed group (P=0.003). Two and one-half times more curative re-resections were performed for recurrent cancer in those patients undergoing intensive follow-up (P=0.0001). Those patients in the intensive follow-up group with a recurrence had a 3.62-times higher survival rate than the control (P=0.0004). Fourteen single-cohort studies were also included in the comparative analysis of 6,641 patients. The findings from these aggregated studies support the results of the meta-analysis. CONCLUSION: Our study concludes that intensive follow-up detects more recurrent cancers at a stage amenable to curative resection, resulting in an improvement in survival of recurrences and an increased overall five-year cumulative rate of survival.

This is a preview of subscription content, log in to check access.


  1. 1.

    Makela JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg 1995;130:1062–7.

  2. 2.

    Ohlsson B, Breland U, Ekberg H, Graffner H, Tranberg KG. Follow-up after curative surgery for colorectal carcinoma: randomized comparison with no follow-up. Dis Colon Rectum 1995;38:619–26.

  3. 3.

    Prati U, Roveda L, Cantoni A,et al. Radioimmunoassisted follow-up and surgery vs. traditional examinations and surgery after radical excision of colorectal cancer. Anticancer Res 1995;15:1081–5.

  4. 4.

    Ovaska J, Jarvinen H, Kujari H, Pertilla I, Mecklin JP. Follow-up of patients operated on for colorectal carcinoma. Am J Surg 1990;159:593–6.

  5. 5.

    Audisio RA, Setti-Carraro P, Segala M,et al. Follow-up in colorectal cancer patients: a cost benefit analysis. Ann Surg Oncol 1996;3:349–57.

  6. 6.

    Malcom AW, Perencevich MD, Olson RM,et al. Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum. Surg Gynecol Obstet 1981;152:131–6.

  7. 7.

    Kronborg O, Fenger C, Deichgraber E, Hansen L. Follow-up after radical surgery for colorectal cancer. Design of a randomized study. Scand J Gastroenterol Suppl 1988;149:159–62.

  8. 8.

    McCall JL, Black RB, Rich CA,et al. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum 1994;37:875–81.

  9. 9.

    Tornqvist A, Eklelund G, Leandoer L. The value of intensive follow-up after curative resection for colorectal carcinoma. Br J Surg 1982;69:725–8.

  10. 10.

    Hida J, Yasutomi M, Shindoh K,et al. Second-look operation for recurrent colorectal cancer based on carcinoembryonic antigen and imaging techniques. Dis Colon Rectum 1996;39:74–9.

  11. 11.

    Bohm B, Schwenk W, Hucke HP, Stick, W. Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma? Dis Colon Rectum 1993;36:280–6.

  12. 12.

    Safi F, Beyer HG. The value of follow-up after curative surgery of colorectal carcinoma. Cancer Detect Prev 1993;17:417–24.

  13. 13.

    Ovaska JT, Jarvinen HJ, Mecklin JP. The value of a follow-up programme after radical surgery for colorectal carcinoma. Scand J Gastroenterol 1989;24:416–22.

  14. 14.

    Camunas J, Enriquez JM, Devesa JM, Morales V, Millan I. Value of follow-up in the management of recurrent colorectal cancer. Eur J Surg Oncol 1991;17:530–5.

  15. 15.

    Martin EW, Minton JP, Carey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 1985;202:310–7.

  16. 16.

    Minton JP, Hoehn JL, Gerber DM,et al. Results of a 400-patient carcinoembryonic antigen second-look colorectal cancer study. Cancer 1985;55:1284–90.

  17. 17.

    Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg 1986;73:342–4.

  18. 18.

    Pugliese V, Aste H, Saccomanno S,et al. Outcome of follow-up programs in patients previously resected for colorectal cancer. Tumori 1984;70:203–8.

  19. 19.

    Deveney KE, Way LW. Follow-up of patients with colorectal cancer. Am J Surg 1984;148:717–22.

  20. 20.

    Cochrane JP, Williams JT, Faber RG, Slack WW. Value of outpatient follow-up after curative surgery for carcinoma of the large bowel. BMJ 1980;128:593–5.

  21. 21.

    Ekman CA, Gustavson J, Henning A. Value of a follow-up study of recurrent carcinoma of the colon and rectum. Surg Gynecol Obstet 1977;145:895–7.

  22. 22.

    Steele G Jr. Follow-up plans after treatment of primary colon and rectum cancer. World J Surg 1991;15:583–8.

  23. 23.

    Olson RM, Perencevich MD, Malcom AW,et al. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer 1980;45:2969–74.

  24. 24.

    Bergamaschi R, Arnaud JP. Routine compared with non-scheduled follow-up of patients with “curative” surgery for colorectal cancer. Ann Surg Oncol 1996;3:464–9.

  25. 25.

    Bruinvels D, Stiggelbort A, Kievit J,et al. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg 1994;219:174–82.

Download references

Author information

Correspondence to Dr. Robert W. Beart Jr. M.D..

About this article

Cite this article

Rosen, M., Chan, L., Beart, R.W. et al. Follow-up of colorectal cancer. Dis Colon Rectum 41, 1116–1126 (1998).

Download citation

Key words

  • Cancer
  • Colon
  • Rectum
  • Recurrent
  • Follow-up