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Intensive surveillance following curative treatment of colorectal cancer allows effective treatment of recurrence even if limited to 4 years

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Current evidence suggests a survival benefit to post-operative surveillance following curative colorectal cancer resection; however, there is still no consensus on the optimal duration and form.

Objectives

The objective is to prospectively audit outcomes of an intensive colorectal cancer follow-up scheme for time to recurrence and survival.

Methods

We used a surveillance protocol designed to incorporate regular clinical, biochemical, radiological and endoscopic measures at pre-defined intervals.

Setting

The setting was a Department of Colorectal Surgery in a Tertiary Academic Centre. Follow-up was led by specially trained colorectal nurses in conjunction with surgeons.

Patients

Consecutive patients who had undergone curative treatment for colorectal cancer were included in this study.

Main outcomes

Outcomes were measured in terms of overall survival and disease recurrence.

Results

There were 436 patients entered into follow-up, all treated with curative intent. Mean age 65.9 years (SD 12.9 years) and 240 male (55.0 %). Ninety-four patients (21.5 %) with stage I disease, 119 (27.3 %) stage IIa, 30 (6.9 %) stage IIb, 18 (4.1 %) stage IIIa, 78 (17.9 %) stage IIIb, 45 (10.4 %) stage IIIc and 52 (11.9 %) stage IV. Overall median survival was 37.5 months for all patients, (range 0.0–207.8 months). Ninety-two (21.1 %) cancer-related deaths were recorded during the course of the study. The overall 5-year actuarial cancer-related survival was 81.7 %. There was a 40.3 % 5-year actuarial survival was recorded in patients with 39 a recurrence, 57.7 % in patients treated with further curative 40 intent and 27.7 % in patients who received palliative treatment 41 (P < 0.001). Ninety-seven percent of recurrences were detected within 4 years of curative treatment.

Conclusions

This follow-up protocol confers an 81 % overall 5-year actuarial survival. Our study suggests that surveillance after curative resection can be limited to 4 years, which would lead to detection of over 97 % of all recurrences.

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA: Cancer J Clin 55(2):74–108

    Google Scholar 

  2. UK CR. Bowel (colorectal) cancer - UK incidence statistics - http://info.cancerresearchuk.org/cancerstats/types/bowel/incidence/#By. 2012

  3. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E et al (2004) Cancer statistics, 2004. CA: Cancer J Clin 54(1):8–29

    Google Scholar 

  4. Rosati G (2010) Intensive or not surveillance of patients with colorectal cancer after curative resection. World J Gastroenterol 16(12):1427–1429

    Article  PubMed Central  PubMed  Google Scholar 

  5. Abulafi AM, Williams NS (1994) Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 81(1):7–19

    Article  CAS  PubMed  Google Scholar 

  6. Jeffery, Hickey, Hider. Follow-up strategies for patients treated for non-metastatic colorectal cancer (Review). Radiation Oncology 2008(4 L1 - file://Z:/NLCRCFU/NLCRCFU Jeffery Cochrane 2008.pdf)

  7. Siegel R, Ward E, Brawley O, Jemal A (2011) Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA: Cancer J Clin 61(4):212–236

    Google Scholar 

  8. Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C et al (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377(9760):127–138

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Sinclair PSA, Riaz AA, Amin A (2012) An unsolved conundrum: the ideal follow-up strategy after curative surgery for colorectal cancer. Gastrointestinal Endoscopy 75(5):1072–1079

    Article  PubMed  Google Scholar 

  10. Chua TC, Liauw W, Chu F, Morris DL (2012) Viewing metastatic colorectal cancer as a curable chronic disease. Am J Clin Oncol 35(1):77–80

    Article  PubMed  Google Scholar 

  11. Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6(1):43–52

    Article  PubMed  Google Scholar 

  12. Wiering B, Vogel WV, Ruers TJ, Oyen WJ (2008) Controversies in the management of colorectal liver metastases: role of PET and PET/CT. Dig Surg 25(6):413–420

    Article  PubMed  Google Scholar 

  13. Sortini D, Feo CV, Carcoforo P et al (2005) Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy. Ann Thorac Surg 79(1):258–262, discussion 262

    Article  PubMed  Google Scholar 

  14. Birgisson H, Talback M, Gunnarsson U, Pahlman L, Glimelius B (2005) Improved survival in cancer of the colon and rectum in Sweden. Eur J Surg Oncol 31(8):845–853

    Article  CAS  PubMed  Google Scholar 

  15. Giordano P, Efron J, Vernava AM 3rd, Weiss EG, Nogueras JJ, Wexner SD (2006) Strategies of follow-up for colorectal cancer: a survey of the American Society of Colon and Rectal Surgeons. Tech Coloproctol 10(3):199–207

    Article  CAS  PubMed  Google Scholar 

  16. Makela JT, Laitinen SO, Kairaluoma MI (1995) Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg 130(10):1062–1067

    Article  CAS  PubMed  Google Scholar 

  17. Ohlsson B, Breland U, Ekberg H, Graffner H, Tranberg KG (1995) Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up. Dis Colon Rectum 38(6):619–626

    Article  CAS  PubMed  Google Scholar 

  18. Kjeldsen BJ, Kronborg O, Fenger C, Jorgensen OD (1997) A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg 84(5):666–669

    Article  CAS  PubMed  Google Scholar 

  19. Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A (1998) Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 41(9):1127–1133

    Article  CAS  PubMed  Google Scholar 

  20. Schoemaker D, Black R, Giles L, Toouli J (1998) Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology 114(1):7–14

    Article  CAS  PubMed  Google Scholar 

  21. Secco GB, Fardelli R, Gianquinto D et al (2002) Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol 28(4):418–423

    Article  PubMed  Google Scholar 

  22. Grossmann EM, Johnson FE, Virgo KS, Longo WE, Fossati R (2004) Follow-up of colorectal cancer patients after resection with curative intent-the GILDA trial. Surg Oncol 13(2-3):119–124

    Article  PubMed  Google Scholar 

  23. Wattchow DA, Weller DP, Esterman A, Pilotto LS, McGorm K, Hammett Z et al (2006) General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer 94(8):1116–1121

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Rodriguez-Moranta F, Salo J, Arcusa A, Boadas J, Piñol V, Bessa X et al (2006) Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol 24(3):386–393

    Article  PubMed  Google Scholar 

  25. Renehan AG, Egger M, Saunders MP, O’Dwyer ST (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 324(7341):813

    Article  PubMed Central  PubMed  Google Scholar 

  26. Tjandra JJ, Chan MK (2007) Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum 50(11):1783–1799

    Article  PubMed  Google Scholar 

  27. Jeyarajah S, Adams K, Higgins L, Ryan S, Leather AJ, Papagrigoriadis S (2011) Prospective evaluation of a colorectal cancer nurse follow-up clinic. Colorectal Dis 13(1):31–8

  28. Gan S, Wilson K, Hollington P (2007) Surveillance of patients following surgery with curative intent for colorectal cancer. World J Gastroenterol 13(28):3816–3823

    Article  PubMed Central  PubMed  Google Scholar 

  29. Laubert T, Bader FG, Oevermann E, Jungbluth T, Unger L, Roblick UJ et al (2010) Intensified surveillance after surgery for colorectal cancer significantly improves survival. Eur J Med Res 15(1):25–30

    PubMed Central  PubMed  Google Scholar 

  30. Howlader NNA KM, Neyman N, Aminou R, Waldron W,, Altekruse SF KC, Ruhl J, Tatalovich Z, Cho H, Mariotto A,, EisnerMP LD, Chen HS, Feuer EJ, Cronin KA, Edwards BK (2010) editors. SEER Cancer Statistics Review, 1975–2008

  31. Morris EJ, Sandin F, Lambert PC, Bray F, Klint A, Linklater K et al (2011) A population-based comparison of the survival of patients with colorectal cancer in England, Norway and Sweden between 1996 and 2004. Gut 60(8):1087–1093

    Article  PubMed  Google Scholar 

  32. Iversen LH (2012) Aspects of survival from colorectal cancer in Denmark. Dan Med J 59(4):B4428

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no competing interests.

Role of funding source

There were no sources of outside funding to declare.

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Authors and Affiliations

  1. Department of Academic Colorectal Surgery, King’s College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK

    Katie Adams, Lynne Higgins, Stella Beazley & Savvas Papagrigoriadis

Authors
  1. Katie Adams
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  2. Lynne Higgins
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  3. Stella Beazley
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  4. Savvas Papagrigoriadis
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Corresponding author

Correspondence to Savvas Papagrigoriadis.

Additional information

Authorship statement

Each of the listed authors has made a substantial contribution to the study concept and design, acquisition of data or analysis and interpretation of data. The listed authors have all approved the final version of the manuscript.

What does this paper add to the literature? The King’s intensive surveillance protocol confers 81 % overall 5-year survival and provides a robust model for survivorship care. Follow-up duration could be limited to 4 years, with subsequent detection of over 97 % of all recurrences, which can improve service efficiency without compromising patient care.

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Adams, K., Higgins, L., Beazley, S. et al. Intensive surveillance following curative treatment of colorectal cancer allows effective treatment of recurrence even if limited to 4 years. Int J Colorectal Dis 30, 1677–1684 (2015). https://doi.org/10.1007/s00384-015-2356-x

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  • DOI: https://doi.org/10.1007/s00384-015-2356-x

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