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.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Safi F, Beyer HG. The value of follow-up after curative surgery of colorectal carcinoma. Cancer Detect Prev 1993;17:417–24.
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.
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.
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.
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.
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.
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.
Deveney KE, Way LW. Follow-up of patients with colorectal cancer. Am J Surg 1984;148:717–22.
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.
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.
Steele G Jr. Follow-up plans after treatment of primary colon and rectum cancer. World J Surg 1991;15:583–8.
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.
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.
Bruinvels D, Stiggelbort A, Kievit J,et al. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg 1994;219:174–82.
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). https://doi.org/10.1007/BF02239433