Skip to main content
SpringerLink
Log in

Cost and effectiveness of follow-up examinations in patients with colorectal cancer resected for cure in a French population-based study

  • Published:
Journal of Gastrointestinal Surgery

Abstract

The cost of follow-up examinations for patients having undergone potentially curative surgery for colorectal cancer is considerable. The aim of this study was to provide a thorough assessment of the cost and effectiveness of the follow-up tests used during the 5 years after surgical resection for colorectal cancer and its recurrences. We studied medical and economic data from the records of 256 patients registered in the Herault Tumor Registry who underwent potentially curative surgical resection in 1992. Recurrence, curative recurrence, survival, and the cost of follow-up tests were assessed respectively for at least 5 years. We analyzed the cost and effectiveness of follow-up tests in patients who received either follow-up with carcinoembryonic antigen (CEA) monitoring as advocated by the 1998 French consensus conference recommendations (standard follow-up) or a more minimal follow-up schedule. Nine patients died in the postoperative period. The 5-year survival rates in the standard and minimal follow-up groups were 85% and 79%, respectively (p = 0.25). Cost-effectiveness ratios were 2123 in Dukes’ stage A patients, 4306 in Dukes’ stage B patients, and 9600 in Dukes’ stage C patients. Cost-effectiveness ratios for CEA monitoring and abdominal ultrasonography per patient alive in the standard follow-up group were 1238 and 2261.5, respectively. Cost-effectiveness ratios for CEA monitoring and abdominal ultrasonography per patient alive in the minimal follow-up group were 1478 and 573, respectively. There were no survivors 5 years after a recurrence when the recurrence was detected by physical examination, chest X-ray, and colonoscopy in either follow-up group. Dukes’ classification is a poor indicator of patient selection. The follow-up tests should only include CEA monitoring and abdominal ultrasonography for the diagnosis of recurrence.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Grosclaude P, Herbert C, Tretare B, et al. Colonic cancer: change in circumstances and techniques of diagnosis in France between 1990 and 1995. Gastroenterol Clin Biol 1998;22:S72-S77.

    PubMed  CAS  Google Scholar 

  2. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–1450.

    Article  Google Scholar 

  3. Ovaska JT, Jaervinen HJ, Mecklin JP. The value of a followup programme after radical surgery of colo-rectal carcinoma. Scand J Gastroenterol 1989;24:416–422.

    PubMed  CAS  Google Scholar 

  4. Langevin JM, Wong WD. What is appropriate follow-up for the patient with colorectal cancer? Can J Surg 1985;28:424–428.

    PubMed  CAS  Google Scholar 

  5. Fucini C, Tommasi SM, Rosi S, et al. Follow-up of colorectal cancer resected for cure: an experience with CEA, TPA, CA19-9 analysis, and second-look surgery. Dis Colon Rectum 1987;30:273–277.

    Article  PubMed  CAS  Google Scholar 

  6. Makela J, Haukipuro K, Laitinen S, et al. Surgical treatment of recurrent colorectal cancer: five-year follow-up. Arch Surg 1989;124:1029–1032.

    PubMed  CAS  Google Scholar 

  7. Audisio RA, Setti Carraro P, Segala M, et al. Follow-up in colorectal cancer patients: a cost-benefit analysis. Ann Surg Oncol 1996;3:349–357.

    Article  PubMed  CAS  Google Scholar 

  8. Fèdèration Nationale des Centres de Lutte Contre le Cancer. Standards options et recommandations pourla priseen charge des malades atteints de cancer du colon. In: Cancers Digestifs, Vol. 2. Paris: Arnette Blackwell, 1995, pp 85–160.

    Google Scholar 

  9. NCCN colorectal cancer practice guidelines. Oncology;1996. 10(Suppl 11):140–175.

    Google Scholar 

  10. Consensus nconference. Prevention, fndiagnosis and treatment of colon cancer. Gastroenterol Clin Biol 1998;22:205–226.

    Google Scholar 

  11. Ohlsson B, Breland U, Ekberg G, et al. Follow-up after curative surgery of colo-rectal carcinoma. Randomized comparison with no follow-up. Dis Colon Rectum 1995;38:619–626.

    Article  PubMed  CAS  Google Scholar 

  12. Makelä J, Laitinen S, Kairaluorna MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg 1995;130:1062–1067.

    PubMed  Google Scholar 

  13. Kjeldsen BJ, Kronborg O, Fenger C, et al. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg 1997;84:666–669.

    Article  PubMed  CAS  Google Scholar 

  14. Schoemaker D, Robert B, Lynn G, et al. Yearly, colonoscopy, liver CT, and chest radiography do not infiuence 5-year survival of colorectal cancer patients. Gastroenterology 1998; 114:7–14.

    Article  PubMed  CAS  Google Scholar 

  15. Pietra N, Sarli L, Costi R, et al. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 1998;41:1127–1133.

    Article  PubMed  CAS  Google Scholar 

  16. Virgo KS, Vernava AM, Longo WE, et al. Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA 1995;273:1837–1841.

    Article  PubMed  CAS  Google Scholar 

  17. Bleeker WA, Mulder NH, Hermans J, et al. Value and cost of follow-up after adjuvant treatment of patients with Dukes’ C colonic cancer. Br J Surg 2001;1:101–106.

    Article  Google Scholar 

  18. Sugarbaker PH, Gianola FJ, Dwyer A, et al. A simplified plan for follow-up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiological test results. Surgery 1987;102:79–87.

    PubMed  CAS  Google Scholar 

  19. Beart RW,O’Connell M. Post-operative follow-up of patients with cancer of the colon. Mayo Clin Proc 1983;58:361–363.

    PubMed  Google Scholar 

  20. Deveney KE, Way LW. Follow-up of patients with colorectal cancer. Am J Surg 1984;148:717–722.

    Article  PubMed  CAS  Google Scholar 

  21. Fantini GA, DeCosse. Surveillance strategies after resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1990;171:267–273.

    PubMed  CAS  Google Scholar 

  22. Kievit J, van de Velde CJ. Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation. A Markov analysis. Cancer 1990;65:2580–2587.

    Article  PubMed  CAS  Google Scholar 

  23. Tempero MA, Williams CA, Anderson JC. The value of hepatic ultrasound and biochemical liver tests in screening for liver metastases. J Clin Oncol 1986;4:1074–1078.

    PubMed  CAS  Google Scholar 

  24. Soyer P, Levesque M, Elias D, et al. Detection of liver metastases from colorectal cancer: comparison of intraoperative US and CT during arterial portography. Radiology 1992;183:541–544.

    PubMed  CAS  Google Scholar 

  25. Devesa JM, Morales V, Enriquez JM, et al. Colorectal cancer. The bases for a comprehensive follow-up. Dis Colon Rectum 1988;31:636–652.

    Article  PubMed  CAS  Google Scholar 

  26. Scharling ES, Wolfman NT, Bechtold RE. Computed tomography evaluation of colorectal carcinoma. Semin Roentgenol 1996;31:142–153.

    Article  PubMed  CAS  Google Scholar 

  27. Kuszyk BS, Bluemke DA, Urban BA, et al. Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: sensitivity based on comparison with intraoperative and pathologic findings. Am J Roentgenol 1996;166:91–95.

    CAS  Google Scholar 

  28. Kelly CJ, Daly JM. Colorectal cancer principles of postoperative follow-up. Cancer Suppl 1992;70:1397–1408.

    CAS  Google Scholar 

  29. Barlow AP, Thompson MH. Colonoscopic follow-up after resection for colorectal cancer: a selective policy. Br J Surg 1993;80:781–784.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Chirurgie Digestive A, Hô pital St. Eloi, 80 Avenue A Fliche, 34295, Montpellier Cedex 5, France

    Frédéric Borie M.D. & Bertrand Millat M.D.

  2. Registre des Tumeurs, Centre de Prevention Epidaure, Val d’Aurelle, rue de la Croix Verte, 34095, Montpellier, France

    Jean-Pierre Daurés M.D. & Brigitte Trétarre M.D.

Authors
  1. Frédéric Borie M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Pierre Daurés M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bertrand Millat M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brigitte Trétarre M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Borie, F., Daurés, JP., Millat, B. et al. Cost and effectiveness of follow-up examinations in patients with colorectal cancer resected for cure in a French population-based study. J Gastrointest Surg 8, 552–558 (2004). https://doi.org/10.1016/j.gassur.2004.02.012

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.gassur.2004.02.012

Key words

Search

Navigation