The Role of Postoperative Surveillance in Colorectal Cancer

 

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ABSTRACT

Postoperative surveillance for recurrent and/or metachronous disease is an important component of the treatment of patients with colorectal cancer. The optimal schedule of follow-up investigations remains controversial. Several randomized trials have suggested a moderate improvement in 5-year survival and earlier detection of cancer recurrence with the implementation of intensive surveillance protocols. Whether these protocols are cost-effective has yet to be determined. Current guidelines from the American Society of Colon and Rectal Surgeons recommend periodic patient follow-up with office visits, carcinoembryonic antigen (CEA) measurement, and endoscopy following potentially curative resection of colorectal cancer.

REFERENCES

• 1 Jemal A, Siegel R, Ward E et al.. Cancer statistics, 2006.  CA Cancer J Clin. 2006;  56 106-130
  Google Scholar
• 2 Vernava A M, Longo W E, Virgo K S et al.. Current follow-up strategies after resection of colon cancer: results of a survey of members of the American Society of Colon and Rectal Surgeons.  Dis Colon Rectum. 1994;  37 573-583
  PubMedGoogle Scholar
• 3 Longo W E, Johnson F E. The preoperative assessment and postoperative surveillance of patients with colon and rectal cancer.  Surg Clin North Am. 2002;  82 1091-1108
  CrossrefPubMedGoogle Scholar
• 4 Ohlsson B, Breland U, Ekberg H et al.. Follow-up after curative surgery for colorectal carcinoma: randomized comparison with no follow-up.  Dis Colon Rectum. 1995;  38 619-626
  CrossrefPubMedGoogle Scholar
• 5 Belluco C, Melega E, Mammano E et al.. Multimodality management of recurrent rectal cancer.  Clin Colon Rectal Surg. 2002;  15(1) 63-70
  PubMedGoogle Scholar
• 6 Rodriguez-Moranta F, Arcusa A, Boadas J. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial.  J Clin Oncol. 2006;  24(3) 386-393
  CrossrefPubMedGoogle Scholar
• 7 Rosen M, Chan L, Beart Jr R W et al.. Follow-up of colorectal cancer: A meta-analysis.  Dis Colon Rectum. 1998;  41 1116-1126
  CrossrefPubMedGoogle Scholar
• 8 Castells A, Bessa X, Daniels M et al.. Value of postoperative surveillance after radical surgery for colorectal cancer: results of a cohort study.  Dis Colon Rectum. 1998;  41 714-724
  CrossrefPubMedGoogle Scholar
• 9 Buie W D, Attard J P. Follow-up recommendations for colon cancer.  Clin Colon Rectal Surg. 2005;  18(3) 232-243
  PubMedGoogle Scholar
• 10 Makela J T, Laitinen O S, Kairaluoma M I. Five-year follow-up after radical surgery for colorectal cancer: results of a prospective randomized trial.  Arch Surg. 1995;  130(10) 1062-1067
  CrossrefPubMedGoogle Scholar
• 11 Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients.  Gastroenterology. 1998;  114 7-14
  CrossrefPubMedGoogle Scholar
• 12 Anthony T, Simmang C, Hyman N et al.. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer.  Dis Colon Rectum. 2004;  47 807-817
  CrossrefPubMedGoogle Scholar
• 13 Pfister D G, Benson III A B, Sornerfield M R. Surveillance strategies after curative treatment of colorectal cancer.  N Engl J Med. 2004;  350(23) 2375-2382
  CrossrefPubMedGoogle Scholar
• 14 Graham R A, Wang S, Catalano P J, Haller D G. Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy.  Ann Surg. 1998;  228 59-63
  CrossrefPubMedGoogle Scholar
• 15 McCall J L, Black R B, Rich C A et al.. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer.  Dis Colon Rectum. 1994;  37 875-881
  CrossrefPubMedGoogle Scholar
• 16 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(9) 1127-1133
  PubMedGoogle Scholar
• 17 Howell J D, Wotherspoon H, Leen E et al.. Evaluation of a follow-up program after curative resection for colorectal cancer.  Br J Cancer. 1999;  79 308-310
  PubMedGoogle Scholar
• 18 Kjeldsen B J, Kronborg O, Fenger C, Jorgensen O D. A prospective randomized study of follow-up after radical surgery for colorectal cancer.  Br J Surg. 1997;  84(5) 666-669
  CrossrefPubMedGoogle Scholar
• 19 de Anda E H, Suk-Hawn L, Finne C O et al.. Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery.  Dis Colon Rectum. 2004;  47 818-824
  CrossrefPubMedGoogle Scholar
• 20 Renehan A G, Egger M, Saunders M P, O'Dwyer S T. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomized trials.  BMJ. 2002;  324(7341) 813
  CrossrefPubMedGoogle Scholar
• 21 Virgo K S, Vernava A M, Longo W E. Cost of patient follow-up after potentially curative colorectal cancer treatment.  JAMA. 1995;  273(23) 1837-1841
  CrossrefPubMedGoogle Scholar
• 22 Bleeker W A, Mulder N H, Hermans J, Otter R, Plukker J TM. Value and cost of follow-up after adjuvant treatment of patients with Duke's C colonic cancer.  Br J Surg. 2001;  88(1) 101-106
  PubMedGoogle Scholar
• 23 NCCN practice guidelines in oncology-v.1. 2007.  Available at: http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf Accessed June 21, 2007
  Google Scholar
• 24 Desch C E, Benson III A B, Somerfield M R et al.. Colorectal cancer surveillance: 2005 update of the American Society of Clinical Oncology Practice Guideline.  J Clin Oncol. 2005;  23(33) 8512-8519
  CrossrefPubMedGoogle Scholar

David A MargolinM.D. 

Department of Colon and Rectal Surgery, Ochsner Clinic Foundation

1514 Jefferson Hwy., New Orleans, LA 70121

Email: damargolin@ochsner.org