Is intensive follow-up really able to improve prognosis of patients with local recurrence after curative surgery for rectal cancer?
BACKGROUND
Because more than 90% of local recurrences after curative surgery for rectal cancer appear within the first 36 months after surgery, an intensive and strict follow-up program during this period could improve early diagnosis and, thus, prognosis of patients.


METHODS
Of the 216 patients who underwent surgery for rectal cancer, 127 entered an intensive follow-up program (median follow-up: 42 months); the clinical outcome of the remaining 89 patients was reconstructed with the help of their general practitioners.


RESULTS
Fifty eight (26.8%) of the 216 patients who were treated with curative surgery alone developed a local recurrence; pelvic recurrences were prevalent. Eleven (30.5%) of the 36 patients who had recurrence during follow-up, and 6 of the 22 who had not undergone follow-up, had a reoperation with curative intent; the median survival was 19 months vs. 8 months, respectively (P = ns). Four (44.4%) curative reoperations were performed on the 9 asymptomatic patients and in 13 (26.5%) of the 49 cases with symptomatic local recurrences. Median survival was 15 months vs. 14 months, respectively (P = n.s). All patients except one (living after 42 months from reoperation) died within 48 months.


CONCLUSIONS
In our study, adherence to a strict follow-up program unfortunately proved to be ineffective for improving long-term survival for patients who underwent reoperation with curative intent.
Secco
G B
GB
Department of Surgery (DICMI), University of Genoa School of Medicine, Italy.
Fardelli
R
R
Rovida
S
S
Gianquinto
D
D
Baldi
E
E
Bonfante
P
P
Derchi
L
L
Ferraris
R
R
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D003365:Costs and Cost Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D010166:Palliative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen