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Follow-Up After Curative Resection of Colorectal Cancer: A Meta-Analysis

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

This is a systematic review to evaluate the impact of various follow-up intensities and strategies on the outcome of patients after curative surgery for colorectal cancer.

Methods

All randomized trials up to January 2007, comparing different follow-up intensities and strategies, were retrieved. Meta-analysis was performed by using the Forest plot review.

Results

Eight randomized, clinical trials with 2,923 patients with colorectal cancer undergoing curative resection were reviewed. There was a significant reduction in overall mortality in patients having intensive follow-up (intensive vs. less intensive follow-up: 21.8 vs. 25.7 percent; P--.01). Regular surveillance with serum carcinoembryonic antigen (P--.0002) and colonoscopy (P--.04) demonstrated a significant impact on overall mortality. However, cancer-related mortality did not show any significant difference. There was no significant difference in all-site recurrence and in local or distant metastasis. Detection of isolated local and hepatic recurrences was similar. Intensive follow-up detected asymptomatic recurrence more frequently (18.9 vs. 6.3 percent; P-lt;-.00001) and 5.91 months earlier than less intensive follow-up protocol; these were demonstrated with all investigation strategies used. Intensive surveillance program detected recurrences that were significantly more amenable to surgical reresection (10.7 vs. 5.7 percent; P--.0002). The chance of curative reresection were significantly better with more intensive follow-up (24.3 vs. 9.9 percent; P--.0001), independent of the investigation strategies used.

Conclusions

Intensive follow-up after curative resection of colorectal cancer improved overall survival and reresection rate for recurrent disease. However, the cancer-related mortality was not improved and the survival benefit was not related to earlier detection and treatment of recurrent disease.

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Correspondence to Miranda K. Y. Chan M.B.B.S., F.R.A.C.S..

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aDeceased.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.

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Tjandra, J.J., Chan, M.K.Y. Follow-Up After Curative Resection of Colorectal Cancer: A Meta-Analysis. Dis Colon Rectum 50, 1783–1799 (2007). https://doi.org/10.1007/s10350-007-9030-5

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  • DOI: https://doi.org/10.1007/s10350-007-9030-5

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