Cited by 392Colorectal Cancer Surgical TreatmentsColorectal Cancer Treatments and StudiesCancer survivorship and care

Follow-up of patients with curatively resected colorectal cancer: a practice guideline

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Figueredo, Alvaro, Rumble, R Bryan, Maroun, Jean, Earle, Craig C, Cummings, Bernard, McLeod, Robin, Zuraw, Lisa, Zwaal, Caroline +1 more·2003·BMC Cancer

Abstract

BACKGROUND: A systematic review was conducted to evaluate the literature regarding the impact of follow-up on colorectal cancer patient survival and, in a second phase, recommendations were developed. METHODS: The MEDLINE, CANCERLIT, and Cochrane Library databases, and abstracts published in the 1997 to 2002 proceedings of the annual meeting of the American Society of Clinical Oncology were systematically searched for evidence. Study selection was limited to randomized trials and meta-analyses that examined different programs of follow-up after curative resection of colorectal cancer where five-year overall survival was reported. External review by Ontario practitioners was obtained through a mailed survey. Final approval of the practice guideline report was obtained from the Practice Guidelines Coordinating Committee. RESULTS: Six randomized trials and two published meta-analyses of follow-up were obtained. Of six randomized trials comparing one follow-up program to a more intense program, only two individual trials detected a statistically significant survival benefit favouring the more intense follow-up program. Pooling of all six randomized trials demonstrated a significant improvement in survival favouring more intense follow-up (Relative Risk Ratio 0.80 (95%CI, 0.70 to 0.91; p = 0.0008). Although the rate of recurrence was similar in both of the follow-up groups compared, asymptomatic recurrences and re-operations for cure of recurrences were more common in patients with more intensive follow-up. Trials including CEA monitoring and liver imaging also had significant results, whereas trials not including these tests did not. CONCLUSION: Follow-up programs for patients with curatively resected colorectal cancer do improve survival. These follow-up programs include frequent visits and performance of blood CEA, chest x-rays, liver imaging and colonoscopy, however, it is not clear which tests or frequency of visits is optimal. There is a suggestion that improved survival is due to diagnosis of recurrence at an earlier, asymptomatic stage which allows for more curative resection of recurrence. Based on this evidence and consideration of the biology of colorectal cancer and present practices, a guideline was developed. Patients should be made aware of the risk of disease recurrence or second bowel cancer, the potential benefits of follow-up and the uncertainties requiring further clinical trials. For patients at high-risk of recurrence (stages IIb and III) clinical assessment is recommended when symptoms occur or at least every 6 months the first 3 years and yearly for at least 5 years. At the time of those visits, patients may have blood CEA, chest x-ray and liver imaging. For patients at lower risk of recurrence (stages I and Ia) or those with co-morbidities impairing future surgery, only visits yearly or when symptoms occur. All patients should have a colonoscopy before or within 6 months of initial surgery, and repeated yearly if villous or tubular adenomas >1 cm are found; otherwise repeat every 3 to 5 years. All patients having recurrences should be assessed by a multidisciplinary team in a cancer centre.

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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 [127]

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Authors
Figueredo, A., Rumble, R. B., Maroun, J., Earle, C. C., Cummings, B., McLeod, R., Zuraw, L., Zwaal, C., & the members of the Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care
Affiliations
  • McMaster University (CA)
  • University of Ottawa (CA)
  • Harvard University (US)
  • University of Toronto (CA)
Corresponding author
Rumble, R Bryan
Venue
BMC Cancer
Published
2003-10-06
Volume
3
Issue
1
Pages
26-26
ISSN
1471-2407 (ISSN-L)
OpenAlex
W1512863196
Cited by
392
References
64
Citations by year
2026: 4 · 2025: 5 · 2024: 8 · 2023: 7 · 2022: 11 · 2021: 11 · 2020: 15 · 2019: 24 · 2018: 12 · 2017: 21 · 2016: 17 · 2015: 27 · 2014: 24 · 2013: 33 · 2012: 32
FWCI
3.45
Type
journal article
Language
en
Open access
Locations
  • BMC Cancer (publishedVersion)
  • PubMed Central (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Cancer Care Ontario
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
colorectal cancer, postoperative follow-up, curative resection, overall survival, tumor recurrence, carcinoembryonic antigen, liver imaging, colonoscopy, chest radiography, recurrence monitoring, follow-up frequency, high-risk patients, low-risk patients
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Statistics as Topic, Colorectal Neoplasms, Meta-Analysis as Topic, Program Evaluation, Survival Analysis, Randomized Controlled Trials as Topic

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