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

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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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Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Hospitals, University of Melbourne, Melbourne, Australia

    Joe J. Tjandra M.D., F.R.A.C.S. & Miranda K. Y. Chan M.B.B.S., F.R.A.C.S.

  2. Department of Surgery, Caritas Medical Centre, 111, Wing Hong Street, Shum Shui Po, Hong Kong

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

Authors
  1. Joe J. Tjandra M.D., F.R.A.C.S.
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  2. Miranda K. Y. Chan M.B.B.S., F.R.A.C.S.
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Correspondence to Miranda K. Y. Chan M.B.B.S., F.R.A.C.S..

Additional information

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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