Top

Published in:

01-08-2006 | Original Article

Assessment of risk-independent follow-up to detect asymptomatic recurrence after curative resection of colorectal cancer

Authors: Matthias Zitt, Gilbert Mühlmann, Helmut Weiss, Reinhold Kafka-Ritsch, Michael Oberwalder, Werner Kirchmayr, Raimund Margreiter, Dietmar Öfner, Alexander Klaus

Published in: Langenbeck's Archives of Surgery | Issue 4/2006

Abstract

Background and aims

Colorectal cancer is one of the leading causes of cancer death. We analyzed the value of standardized, risk-independent postoperative surveillance.

Materials and methods

Between 1995 and 2001, 564 patients with colorectal cancer underwent standardized oncologic resection. One hundred thirty-four were unable to take part in the surveillance program, while 430 patients were grouped as follows: group I (n=272, risk-independent follow-up), group II (n=113, follow-up at other departments), and group III (n=45, no follow-up).

Results

The 5-year cancer-specific survival rate for UICC III and IV was significantly higher in group I (87%) as compared to group II (35%). In group I, the 5-year disease-free survival rate was 70%. Cancer recurrence occurred at mean 17 (±12) months after colorectal resection and yielded a 5-year survival rate of 63%. Reresection was performed in 17 (35%) patients, of whom ten remained disease-free (5-year survival rate, 91%). The money spent for one patient’s 5-year follow-up was 1665.

Conclusions

A standardized, risk-independent follow-up program allows early diagnosis of asymptomatic recurrence of colorectal cancer. Reresection improves the 5-year survival rate in this setting.

Landis SH, Murray T, Bolden S et al (1999) Cancer statistics. CA Cancer J Clin 49:8–31PubMedCrossRef

Jemal A, Murray T, Samuels A et al (2003) Cancer statistics. CA Cancer J Clin 53:5–26PubMedCrossRef

Pisani P, Parkin DM, Bray F, Ferlay J (1999) Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 83:18–29PubMedCrossRef

Boring CC, Squires TS, Tong T, Montgomery S (1994) Cancer statistics. CA Cancer J Clin 94(44):7–26CrossRef

EUCAN database: 1998 estimates, version 5.0 (created 17.03.2003)

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

Rosen M, Chan L, Beart RW Jr et al (1998) Follow-up of colorectal cancer. Dis Colon Rectum 41:1116–1126PubMedCrossRef

Fong Y, Blumgart LH (1998) Hepatic colorectal metastasis: current status of surgical therapy. Oncology 10:1489–1498

Rees M, Plant G, Bygrave S (1997) Late results justify resection for multiple hepatic metastases from colorectal cancer. Br J Surg 84:1136–1140PubMedCrossRef

10.

Ike H, Shimada H, Togo S et al (2002) Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer. Br J Surg 89:1164–1168PubMedCrossRef

11.

Peethamabaram P, Weiss M, Loprinzi CL et al (1997) An evaluation of postoperative follow-up tests in colon cancer patients treated for cure. Oncology 54:287–292CrossRef

12.

Goldberg RM, Fleming TR, Tangen CM et al (1998) Surgery for recurrent colon cancer: strategies for identifying respectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, The North Central Cancer Treatment Group, and the South West Oncology Group. Ann Intern Med 129:27–35PubMed

13.

Jeffery GM, Hickey BE, Hider P (2002) Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev (1):CD002200

14.

Renehan A, O’Dwyer ST, Whynes DK (2004) Cost effectiveness analysis of intensive versus conventional follow-up after curative resection for colorectal cancer. Br Med J 328:81CrossRef

15.

Polk HC Jr, Spratt JS Jr (1971) Recurrent colorectal carcinoma: detection, treatment, and other considerations. Surgery 69:9–23 (Jan)PubMed

16.

Schorr M, Siebeck M, Hohenbleicher F, Zoller WG (1999) Colorectal cancer: a rational follow-up program adapted to patient's individual risk of recurrence and review of the literature. Eur J Med Res 4(7):275–282 (Jul 28)PubMed

17.

Bonthuis DC, Landheer ML, Spillenaar Bilgen EJ et al (2004) Small but significant survival benefit in patients who undergo routine follow-up after colorectal cancer surgery. Eur J Surg Oncol 30:1093–1097PubMedCrossRef

18.

Schrag D, Panageas KS, Riedel E et al (2003) Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol 83(2):68–78 (Jun)PubMedCrossRef

19.

Chiappa A, Zbar AP, Bertani E et al (2001) Surgical outcomes for colorectal cancer patients including the elderly. Hepatogastroenterology 48(38):440–444 (Mar–Apr)PubMed

20.

Leroy J, Jamali F, Forbes L et al (2003) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18(2):281–289PubMed

21.

Lauder C, Hemmingway D, Sutton C (2003) Recurrence and survival after mesorectal excision for rectal cancer. Br J Surg 90(12):1610 (Dec)PubMedCrossRef

22.

Pietra N, Sarli L, Costi R et al (1998) Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 41(9):1127–1133 (Sep)PubMedCrossRef

23.

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 (Oct)PubMed

24.

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 (Jan)PubMedCrossRef

25.

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

26.

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 (May)PubMedCrossRef

27.

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 (Jun)PubMedCrossRef

28.

Virgo KS, Vernava AM, Longo WE et al (1995) Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA 273(23):1837–1841 (Jun 21)PubMedCrossRef

29.

Staib L, Link KH, Beger HG (2000) Follow-up in colorectal cancer: cost-effectiveness analysis of established and novel concepts. Langenbecks Arch Surg 385(6):412–420 (Oct)PubMedCrossRef

30.

Cunningham D, Pyrhonen S, James RD et al (1998) Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138):1413–1418 (Oct 31)PubMedCrossRef

31.

Fusai G, Davidson BR (2003) Management of colorectal liver metastases. Colorectal Dis 5(1):2–23 (Jan)PubMedCrossRef

32.

Blumgart LH, Fong Y (1995) Surgical options in the treatment of hepatic metastasis from colorectal cancer. Curr Probl Surg 32(5):333–421 (May)PubMedCrossRef

33.

Gazzaniga GM, Ciferri E, Fazio S et al (1995) Repeated hepatic resections for recurrent metastasis of colorectal cancer. Hepatogastroenterology 42(4):383–386 (Jul–Aug)PubMed

34.

McCormack PM, Burt ME, Bains MS et al (1992) Lung resection for colorectal metastases. 10-year results. Arch Surg 127(12):1403–1406 (Dec)PubMed

Title: Assessment of risk-independent follow-up to detect asymptomatic recurrence after curative resection of colorectal cancer
Authors: Matthias Zitt
Gilbert Mühlmann
Helmut Weiss
Reinhold Kafka-Ritsch
Michael Oberwalder
Werner Kirchmayr
Raimund Margreiter
Dietmar Öfner
Alexander Klaus
Publication date: 01-08-2006
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 4/2006
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-006-0045-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of risk-independent follow-up to detect asymptomatic recurrence after curative resection of colorectal cancer

Abstract

Background and aims

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2006

Short-term preoperative radiotherapy in rectal cancer patients leads to a reduction of the detectable number of lymph nodes in resection specimens

A comparative analysis of phenotype expression in human osteoblasts from heterotopic ossification and normal bone

Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy

Reply to the letter by C. Chauveau et al. on our publication “A comparative analysis of phenotype expression in human osteoblasts from heterotopic ossification and normal bone”

Electrical impedance tomography: changes in distribution of pulmonary ventilation during laparoscopic surgery in a porcine model

Robotic-assisted transhiatal esophagectomy