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Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials

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Renehan, Andrew G, Egger, Matthias, Saunders, Mark P, O'Dwyer, Sarah T·2002·BMJ
DOI 10.1136/bmj.324.7341.813PMC PMC100789
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Abstract

Objective: To review the evidence from clinical trials of follow up of patients after curative resection for colorectal cancer. Design: Systematic review and meta-analysis of randomised controlled trials of intensive compared with control follow up. Main outcome measures: All cause mortality at five years (primary outcome). Rates of recurrence of intraluminal, local, and metastatic disease and metachronous (second colorectal primary) cancers (secondary outcomes). Results: Five trials, which included 1342 patients, met the inclusion criteria. Intensive follow up was associated with a reduction in all cause mortality (combined risk ratio 0.81, 95% confidence interval 0.70 to 0.94, P=0.007). The effect was most pronounced in the four extramural detection trials that used computed tomography and frequent measurements of serum carcinoembryonic antigen (risk ratio 0.73, 0.60 to 0.89, P=0.002). Intensive follow up was associated with significantly earlier detection of all recurrences (difference in means 8.5 months, 7.6 to 9.4 months, P<0.001) and an increased detection rate for isolated local recurrences (risk ratio 1.61, 1.12 to 2.32, P=0.011). Conclusions: Intensive follow up after curative resection for colorectal cancer improves survival. Large trials are required to identify which components of intensive follow up are most beneficial. What is already known on this topic: There is a lack of direct evidence that intensive follow up after initial curative treatment for colorectal cancer leads to increased survival Guidelines are inconclusive and clinical practice varies widely What this study adds: The cumulative analysis of available data supports the view that intensive follow up after curative resection for colorectal cancer improves survival If computed tomography and frequent measurements of serum carcinoembryonic antigen are used during follow up mortality related to cancer is reduced by 9-13% This survival benefit is partly attributable to the earlier detection of all recurrences, particularly the increased detection of isolated recurrent disease

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  • Surveillance after curative surgical resection of colorectal cancer contributes to improving the resection rate of recurrent tumors and to improving prognosis.

    “Meta-analyses of RCTs conducted in Europe and the United States have shown that surveillance after curative surgical resection of colorectal cancer contributes to improving the resection rate of recurrent tumors and to improving the prognosis [127–131]”

    From Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer (2018) · cites this paper as [129]

    The All cause mortality section reports lower five-year mortality with intensive follow-up after curative colorectal cancer surgery, supporting the prognosis claim. The Recurrences, metastases, and metachronous cancers section reports earlier detection and more detection of isolated local recurrences, but it does not establish an increased rate of surgical resection of recurrent tumors. The paper evaluates intensive versus control follow-up, rather than surveillance versus no surveillance. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • More intensive follow-up of colorectal cancer reduces mortality.

    “there is evidence for more intensive follow up of colorectal cancer reducing mortality (Renehan et al, 2002)”

    From Personalised cancer follow-up: risk stratification, needs assessment or both? (2012) · cites this paper as Renehan et al, 2002

  • There are as yet very few cancers where there is good evidence that early identification of recurrence reduces mortality.

    “However, there are as yet very few cancers, where there is good evidence to suggest early identification of recurrence reduces mortality: there is evidence for more intensive follow up of colorectal cancer reducing mortality (Renehan et al, 2002), but not breast cancer (Rojas et al, 2005).”

    From Personalised cancer follow-up: risk stratification, needs assessment or both? (2012) · cites this paper as Renehan et al, 2002

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Research works printed but not linked: 1

  1. Rosen M, Chan L, Beart RW Jr, Vukasin P, Anthone G. Follow-up of colo- rectal cancer: a meta-analysis. Dis Colon Rectum 1998;41:1116-26.

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Authors
Renehan, A. G., Egger, M., Saunders, M. P., & O'Dwyer, S. T.
Affiliations
  • The Christie Hospital (GB)
  • University of Bristol (GB)
  • Department of Surgery, Christie Hospital NHS Trust, Manchester M20 4BX
Corresponding author
Renehan, Andrew G
ORCID
Venue
BMJ
Publisher
BMJ
Published
2002-04-06
Volume
324
Issue
7341
Pages
813
ISSN
  • 1756-1833 (ISSN-L)
  • 0959-8138
DOI
10.1136/bmj.324.7341.813
PMC
PMC100789
OpenAlex
W2150339343
Cited by
651
References
41
Citations by year
2026: 7 · 2025: 10 · 2024: 7 · 2023: 9 · 2022: 17 · 2021: 28 · 2020: 19 · 2019: 26 · 2018: 18 · 2017: 30 · 2016: 31 · 2015: 42 · 2014: 30 · 2013: 39 · 2012: 48
FWCI
2.83
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
Keywords
colorectal cancer, postoperative follow-up, intensive follow-up, curative resection, all-cause mortality, tumor recurrence, local recurrence, metachronous colorectal cancer, carcinoembryonic antigen, computed tomography surveillance, early detection of recurrence
MeSH terms
Humans, Long-Term Care, Neoplasm Metastasis, Postoperative Period, Recurrence, Colorectal Neoplasms, Survival Rate, Randomized Controlled Trials as Topic

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