Annals of Surgical Oncology

, Volume 3, Issue 4, pp 349–357 | Cite as

Follow-up in colorectal cancer patients: A cost-benefit analysis

  • Riccardo A. Audisio
  • Paolo Setti-Carraro
  • Marco Segala
  • Deborah Capko
  • Bruno Andreoni
  • Giorgio Tiberio
Original Articles


Background: No conclusive evidence exists concerning the effectiveness of follow-up programs after curative surgery for colorectal cancer, and presently cost-benefit analyses have not indicated that follow-up strategies increase survival or quality of life.

Methods: Five hundred five patients who survived curvative surgery for stage I–III colorectal adenocarcinoma were closely followed for at least 4 years.

Results: One hundred forty-one (28%) patients had recurrence. Of these, 32 underwent one or more surgical procedures for cure, whereas 109 could only benefit from palliation. Eighteen were cured. The mean survival of all recurrent cases was 44.4 months. Of those operated on with curative intent, the mean survival was 69.3 months compared with 37.1 months in those operated on with palliative intent. Of those 18 patients who were cured by reoperative surgery, the average survival was 81.4 months. The overall follow-up cost was $1,914,900 (U.S.) for the 505 patients; $13,580 (U.S.) for each recurrence, $59,841 (U.S.) for each case treated for cure, and $136,779 (U.S.) for those effectively cured.

Conclusions: Careful postoperative monitoring is expensive yet effective when one considers that one-quarter of the detected recurrences were suitable for potentially curative second surgery; however, only 3.6% of the original group were effectively cured. Follow-up programs should be tailored according to the stage and site of the primary to reduce costs.

Key Words

Colorectal neoplasm Follow-up Reoperation Costs 


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  1. 1.
    Mantel N. Chi square tests with one degree of freedom extensions of the Mantel-Haenszel procedures.J Am Stat Assoc 1963;58:620–5.Google Scholar
  2. 2.
    Devesa JM, Morales V, Enriquez JM, et al. Colorectal cancer. The bases for a comprehensive follow up.Dis Colon Rectum 1988;31:636–52.PubMedGoogle Scholar
  3. 3.
    Willett CG, Tepper JE, Cohen AM, et al. Failure patterns following curative resection of colonic carcinoma.Ann Surg 1984;200:685–90.PubMedGoogle Scholar
  4. 4.
    Phillips RKS, Hittinger R, Blesovsky L, et al. Local recurrence following “curative” surgery for large bowel cancer. The overall picture.Br J Surg 1984;71:12–6.PubMedGoogle Scholar
  5. 5.
    Beal JM, Cornell GN. A study of the problem of recurrence of carcinoma at the anastomotic site following resection of the colon carcinoma.Ann Surg 1956;143:1–7.PubMedGoogle Scholar
  6. 6.
    Wright HK, Thomas WH, Cleveland JC. The low recurrence rate of colonic carcinoma in ileocolic anastomoses.Surg Gynecol Obstet 1969;129:960–2.PubMedGoogle Scholar
  7. 7.
    Vernava AM, Longo WE, Virgo KS, et al. Current follow up strategies after resection of colon cancer.Dis Colon Rectum 1994;37:573–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Polk HC, Spratt JS Jr, Butcher HR Jr. Frequency of multiple primary malignant neoplasms associated with colorectal carcinoma.Am J Surg 1965;109:71–5.PubMedGoogle Scholar
  9. 9.
    Weir JA. Colorectal cancer: metachronous and other associated neoplasms.Dis Colon Rectum 1975;18:4–5.PubMedGoogle Scholar
  10. 10.
    Beart RW, O'Connell MJ. Postoperative follow up of patients with carcinoma of the colon.Mayo Clin Proc 1983;58:361–3.PubMedGoogle Scholar
  11. 11.
    Cochrane JPS, Williams JT, Faber RG, Slack WW. Value of outpatient follow up after curative surgery for carcinoma of the large bowel.Br Med J 1980;280:593–5.PubMedGoogle Scholar
  12. 12.
    Deveney KM, Way LW. Follow up of patients with colorectal cancer.Am J Surg 1984;148:717–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Isbister WH. The follow up of patients following surgery for colorectal cancer: a personal view.Ann Acad Med 1988;17:66–71.Google Scholar
  14. 14.
    Sugarbaker PH, Gianola FJ, Dwyer A, Neuman NR. A simplified plan for follow up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results.Surgery 1987;102:79–87.PubMedGoogle Scholar
  15. 15.
    Törnquist A, Ekelund G, Leandoer L. The value of intensive follow up after curative resection for colorectal carcinoma.Br J Surg 1982;69:725–8.Google Scholar
  16. 16.
    Böhm B, Schwenk W, Hucke HP. Does methodic long term follow up affect survival after curative resection of colorectal carcinoma?Dis Colon Rectum 1993;36:280–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Welch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum.Am J Surg 1978;135:505–11.CrossRefPubMedGoogle Scholar
  18. 18.
    Beart RW Jr. Postoperative follow up of colorectal cancer. In: Beahrs OH, Higgins GA, Weinstein JJ, eds.Colorectal tumors. Philadelphia: JB Lippincott, 1986:299–301.Google Scholar
  19. 19.
    Kelly CJ, Daly JM. Colorectal cancer—principles of postoperative follow up.Cancer 1992;70:1397–413.PubMedGoogle Scholar
  20. 20.
    Fantini GA, DeCosse JJ. Surveillance strategies after resection of carcinoma of the colon and rectum.Surgery 1990;171:267–73.Google Scholar
  21. 21.
    Minton JP, Hoen JL, Gerber DM, et al. Results of a 400 patient carcinoembryonic antigen second look colorectal cancer study.Cancer 1985;55:1284–90.PubMedGoogle Scholar
  22. 22.
    Bahler H, Seefeld U, Deyhle P, et al. Endoscopic follow up after colorectal surgery.Cancer 1984;54:791–4.Google Scholar
  23. 23.
    Martin EW, Cooperman M, Carey LC, Minton JP. Sixty second-look laparotomies indicated by rise in serial carcinoembryonal antigen.J Surg Res 1980;28:389–94.CrossRefPubMedGoogle Scholar
  24. 24.
    Mäkelä J, Laitinen S, Kairaluoma MI. Early results of follow up after radical resection for colorectal cancer. Preliminary results of a prospective randomised trial.Surg Oncol 1992;1:157–61.PubMedGoogle Scholar
  25. 25.
    Mendez RJ, Rodriguez R, Kovachevich T, et al. CT in local recurrence of rectal carcinoma.J Comput Assist Tomogr 1993;17:741–4.PubMedGoogle Scholar
  26. 26.
    Weber CA, Deveney KE. Routine colonoscopy in the management of colorectal carcinoma.Am J Surg 1986;152:87–90.PubMedGoogle Scholar
  27. 27.
    Kronborg O, Hage E, Deichgraeber E. The remaining colon after radical surgery for colorectal cancer: the first three years of a prospective study.Dis Colon Rectum 1983;26:172–6.PubMedGoogle Scholar
  28. 28.
    Juhl G, Larson GM, Mullins R, et al. Six year results of annual colonoscopy after resection of colorectal cancer.World J Surg 1990;14:255–61.CrossRefPubMedGoogle Scholar
  29. 29.
    Patchett SE, Mulcahy HE, O'Donoghue DP. Colonoscopic surveillance after curative resection for colorectal cancer.Br J Surg 1993;80:1330–2.PubMedGoogle Scholar
  30. 30.
    Mecklin JP, Järvinen H. Treatment and follow up strategies in hereditary nonpolyposis colorectal carcinoma.Dis Colon Rectum 1993;36:927–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Cali RL, Pitsch RM, Thorson AG, et al. Cumulative incidence of metachronous colorectal cancer.Dis Colon Rectum 1993;36:388–93.PubMedGoogle Scholar
  32. 32.
    Moffat FL. Letter to the Editor.Am J Gastroenterol 1992;3:404.Google Scholar
  33. 33.
    Moffat FL. Comprehensive surveillance after curative surgery for adenocarcinoma of the colon.Am J Gastroenterol 1991;86:939–40.PubMedGoogle Scholar
  34. 34.
    Welch JP, Donaldson GA. Detection and treatment of recurrent cancer of the colon and rectum.Am J Surg 1978;135:505.CrossRefPubMedGoogle Scholar
  35. 35.
    Winchester DP, McBride CM. Cancer of the colon; a comparison of survival factors.South Med J 1974;67:1029.Google Scholar
  36. 36.
    Gunderson J, Sosin H. Areas of failure found at reoperation (second or asymptomatic look) following curative surgery for adenocarcinoma of the rectum.Cancer 1974;34:1278–92.PubMedGoogle Scholar
  37. 37.
    Wanebo HJ, Gaker DL, Whitehill R, et al. Pelvic recurrence of rectal cancer: options for curative resection.Ann Surg 1987;205:482–95.PubMedGoogle Scholar
  38. 38.
    Pealman NW, Donohue RE, Stiegmann GV, et al. Pelvic and sacropelvic exenteration for locally advanced or recurrent anorectal cancer.Arch Surg 1987;122:537–41.Google Scholar
  39. 39.
    Benotti P, Steele G Jr. Patterns of recurrent colorectal cancer and recovery surgery.Cancer 1992;70:1409–13.PubMedGoogle Scholar
  40. 40.
    Hemming AW, Langer B. Repeat resection of recurrent hepatic colorectal metastases.Br J Surg 1994;81:1553–4.PubMedGoogle Scholar
  41. 41.
    Bozzetti F, Bignami P, Morabito A, Doci R, Gennari L. Patterns of failure following surgical resection of colorectal liver metastases.Ann Surg 1987;205:264–70.PubMedGoogle Scholar
  42. 42.
    McCormack PM, Burt ME, Bains MS, Martini N, Rusch VW, Ginsberg R. Lung resection for colorectal metastases; 10 year results.Arch Surg 1992;127:1403–6.PubMedGoogle Scholar
  43. 43.
    Wilking N, Petrelli NJ, Herrera L, Regal AM, Mittelman A. Surgical resection of pulmonary metastases from colorectal adenocarcinoma.Dis Colon Rectum 1985;28:562–4.PubMedGoogle Scholar
  44. 44.
    Metzger U, Bronz K, Bühler H, et al. Die prospektive nachsorgestudie radikal operierter kolorektaler karzionme.Schweiz Med Wochenschr 1985;115:1001–4.PubMedGoogle Scholar
  45. 45.
    Mentges B. Kontrversen in der nachsorge des kolonkarzinoms.Zentralbl Chir 1988;113:1087–91.PubMedGoogle Scholar
  46. 46.
    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.PubMedGoogle Scholar
  47. 47.
    Ovaska JT, Järvinen H, Mecklin JP. The value of a follow up programme after radical surgery for colorectal carcinoma.Scand J Gastroenterol 1989;24:416–22.PubMedGoogle Scholar
  48. 48.
    Ovaska JT, Järvinen H, Kujari H, Perttilä I, Mecklin JP. Follow up of patients operated on for colorectal carcinoma.Am J Surg 1990;159:593–6.PubMedGoogle Scholar
  49. 49.
    Schiessel R, Wenzl E. Was bringt die nachsorge beim kolorektalen karzinom?Wien Med Wochenschr 1988;11:263–6.Google Scholar
  50. 50.
    Schildberg FW. Probleme des lokalrezidivs nach colorectalem carcinom.Langenbecks Arch Chir 1987;372:505–11.PubMedGoogle Scholar
  51. 51.
    Mentges B, Mentges W, Grüssner R, Brückner R. Art und prognose des lokoregionären rezidivs beim rektumkarzinom.Dtsch Med Wochenschr 1988;113:806–10.PubMedGoogle Scholar
  52. 52.
    Mentges B, Brückner R. Prognostische kriterien und risikogruppen beim kolorektal karzinom.Wien Med Wochenschr 1988;13:317–22.Google Scholar
  53. 53.
    Camuñas J, Enriquez JM, Devesa JM, et al. Value of follow up in the management of recurrent colorectal cancer.Eur J Surg Oncol 1991;17:530–5.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 1996

Authors and Affiliations

  • Riccardo A. Audisio
    • 2
  • Paolo Setti-Carraro
    • 1
  • Marco Segala
    • 1
  • Deborah Capko
    • 2
  • Bruno Andreoni
    • 2
  • Giorgio Tiberio
    • 1
  1. 1.From the Istituto di Chirurgia d'UrgenzaUniversità di MilanoMilanItaly
  2. 2.General Surgery 2EIO-European Institute of OncologyMilanItaly

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