Abstract
Background: The main rationale for follow-up of colorectal cancer patients resected for “cure” is that early detection and treatment of recurrence and metachronous disease should result in improved survival. Our purpose was to assess in a prospective fashion the impact on survival of a follow-up program versus that of undergoing nonscheduled visits.
Methods: Within the 14-year period from 1975 through 1988, a prospective study was carried out on 800 patients with colorectal adenocarcinoma radically resected with no evidence of synchronous cancers of the colon and rectum or in other organs, of whom 322 patients were to attend a 5-year follow-up, and 478 patients were free to make nonscheduled visits on account of symptoms.
Results: Asymptomatic recurrence was found at follow-up in 92 (28%) of 322 patients, whereas 175 (36%) of 478 patients had a symptomatic recurrence detected at a nonscheduled visit. Diagnosis of resectable recurrence was established within a median time of 21.5 months. Surgical resection of recurrence was performed in 30 (32%) of 92 and in 13 (7%) of 175 patients (32 vs. 7%;p<0.001). Resection was curative in 13 (14%) of 92 and in two (1%) of 175. Five-year survival of resected recurrence was 10% in 30 of 92 patients and 0.8% in 13 of 175 (10 vs. 0.8%;p<0.01). Two patients are alive with no evidence of disease or two (2%) of 92. Metachronous colorectal lesions were treated for cure in 63 (19.5%) of 322 patients. The effectiveness of scheduled follow-up was 4% (13 of 322 patients).
Conclusions: These results underline the rationale for a follow-up program in early detection and surgical treatment of recurrent disease in patients operated on for colorectal cancer.
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References
Ekelund G. The colorectal surgeon's scientific and economic responsibility.Dis Colon Rectum 1993;36:728–30.
Beart RW, Metzger PP, O'Connel MJ, Schutt AJ. Postoperative screening of patients with carcinoma of the colon.Dis Colon Rectum 1981;24:585–8.
Nava H, Pagana TJ. Postoperative surveillance of colorectal cancer.Cancer 1982;49:1043–7.
Tornqvist A, Ekelund G, Leandoer L. The value of intensive follow-up after curative resection for colorectal carcinoma.Br J Surg 1982;69:725–8.
Beart RW, O'Connel MJ. Postoperative follow-up of patients with carcinoma of the colon.Mayo Clin Proc 1983;58:361–3.
Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence.Surgery 1986;1000:278–84.
Vons C, Houry S, Lacaine F, Huguier M. Treatment of local recurrence after primary restorative resection or Hartmann's operation for carcinoma of the colon and rectum.Int J Colorectal Dis 1986;1:227–30.
Kronborg O, Fenger C, Deichgraeber E, Hansen L. Follow-up after radical surgery for colorectal cancer: design of a randomized study.Scand J Gastroenterol 1988;149(suppl):159–62.
Ballantyne GH, Modlin IM. Postoperative follow-up for colorectal cancer: who are we kidding? [Editorial].J Clin Gastroenterol 1988;10:359–64.
Wenzl E, Wunderlich M, Herbst F, et al. Results of rigorous follow-up.Int J Colorectal Dis 1988;3:176–80.
Silen W. Hepatic resection for metastases from colorectal carcinoma is of dubious value.Arch Surg 1989;124:1021–2.
Hulton NR, Hargreaves AW. Is long-term follow-up of all colorectal cancer necessary?J R Coll Surg Edinb 1989;34:21–4.
Fernandez-Trigo V, Shamsa F, Aldrete J, Andersson R, Arnaud JP, Bergamaschi R, Ciferri E, et al. Repeat liver resections from colorectal metastasis. Repeat Hepatic Resection Registry.Cancer Treat Res 1994:185–96.
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.
Malcolm AW, Perencevich NP, 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.
Mackey AM, Patel S, Carter S, et al. Role of serial plasma CEA assays in detection of recurrent and metastatic colorectal carcinoma.Br Med J 1974;4:382–5.
Herrera M, Chu TM, Holyoke ED. Carcinoembryonic antigen (CEA) as a prognostic and monitoring test in clinically complete resection of colorectal cancer.Ann Surg 1976;183:5–9.
Neville AM, Cooper EH. Biochemical monitoring of cancer.Ann Biochem 1976;13:283–305.
Sugarbaker PH, Zamcheck N, Moore FD. Assessment of serial carcinoembryonic antigen (CEA) assays in postoperative detection of recurrent colorectal cancer.Cancer 1976;38:2310–5.
Mach JP, Vienny H, Jaeger P, et al. Long-term follow-up of colorectal carcinoma patients by repeated CEA radioimmunoassay.Cancer 1978;42:1439–47.
Wanebo HJ, Stearns M, Schwartz MK. Use of CEA as an indicator of early recurrence and as a guide to a selected second-look procedure in patients with colorectal cancer.Ann Surg 1978;188:481–93.
Steele G Jr, Zamcheck N, Wilson R, et al. Results of CEA-initiated second-look surgery for recurrent colorectal cancer.Am J Surg 1980;139:544–8.
Carlsson V, Stewenius J, Ekelund G, et al. Is CEA analysis of value in screening for recurrences after surgery for colorectal carcinoma?Dis Colon Rectum 1983;26:369–73.
Zeng Z, Cohen AM, Urmacher C. Usefulness of carcinoembryonic antigen monitoring despite normal preoperative values in node-positive colon cancer patients.Dis Colon Rectum 1993;36:1063–8.
Minton JP, Martin EW Jr. The use of serial CEA determinations to predict recurrence of colon cancer and when to do a second-look operation.Cancer 1978;42:1422–7.
Attineh FF, Stearns MW Jr. Second-look laparotomy based on CEA elevations in colorectal cancer.Cancer 1981;47:2119–25.
Sandler RS, Freund DA, Herbst LA, Sandler DP. Cost effectiveness of postoperative carcinoembryonic antigen monitoring in colorectal cancer.Cancer 1984;53:193–8.
Kievit J, van de Velde CJH. Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation: a Markov analysis.Cancer 1990;65:2580–7.
Rocklin MS, Slomski CA, Watne AL. Postoperative surveillance of patients with carcinoma of the colon and rectum.Am Surg 1990;56:22–7.
Safi F, Link KH, Beger HG. Is follow-up of colorectal cancer patients worthwhile?Dis Colon Rectum 1993;36:636–44.
Northover JMA. Carcinoembryonic antigen and recurrent colorectal cancer.Br J Surg 1985;72(suppl):44–6.
Keighley MRB, Hall C. Anastomotic recurrence of colorectal cancer: a biological phenomenon or an avoidable calamity?Gut 1987;28:786–91.
Umpleby HC, Williamson RCN. Anastomotic recurrence in large bowel cancer.Br J Surg 1987;74:873–8.
Juhl G, Larson GM, Mullins R, et al. Six year results of annual colonoscopy after resection of colorectal cancer.World J Surg 1990;14:255–60.
Kaplan E, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–81.
Bruinvels DJ, Stiggelbout AM, Kievit J, et al. Follow-up of patients with colorectal cancer: a meta-analysis.Ann Surg 1994;219:174–9.
Vernava AM, Longo WE, Virgo KS, et al. Current follow-up strategies after resection of colon cancer.Dis Colon Rectum 1994;37:573–83.
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.
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Bergamaschi, R., Arnaud, JP. Routine compared with nonscheduled follow-up of patients with “curative” surgery for colorectal cancer. Annals of Surgical Oncology 3, 464–469 (1996). https://doi.org/10.1007/BF02305764
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DOI: https://doi.org/10.1007/BF02305764