Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial.
OBJECTIVE
This paper aims to evaluate the diagnostic efficacy and costs of follow-up tailored according to risk of recurrence compared with minimal surveillance.


METHODS
A total of 358 patients treated by surgery alone for colorectal cancer were prospectively divided into two groups of 200 and 158 patients considered at high and low risk of recurrence respectively, according to prognostic factors. They were further randomized into two subgroups: group 1, 192 patients undergoing risk-adapted follow-up, intensive and low-intensity; group 2, 145 patients undergoing minimal surveillance. Twenty-one cases dropped out. Median follow-up was 61.5 months and 42 months for cases at high risk (intensive follow-up) and at low risk (low-intensity follow-up) respectively.


RESULTS
At the end of the study, 52.6% of patients undergoing risk-adapted follow-up and 57.2% undergoing minimal follow-up had developed recurrence. In patients at high risk, a significant difference in the incidence of curative re-operations was observed between the subgroups undergoing risk-adapted follow-up and subgroups undergoing minimal surveillance (P<0.05). The actuarial 5 year survival of patients at high and at low risk of recurrence undergoing risk-adapted follow-up is significantly better than that of cases undergoing minimal follow-up. The economic costs for 34 patients in the intensive follow-up group and for the 57 patients in the low-intensity follow-up group who were free from disease after primary surgery was very similar.


CONCLUSIONS
Risk-adapted follow-up has significantly improved the targeting of curative re-operations and overall survival of patients independently of risk of recurrence and has allowed a reduction in the costs of following up of disease-free patients.
Secco
Giovanni B
GB
DICMI - Sezione di Semeiotica Chirurgica I, University of Genoa School of Medicine, Genoa, Italy.
Fardelli
Roberto
R
Gianquinto
Daniela
D
Bonfante
Pierfrancesco
P
Baldi
Eleonora
E
Ravera
Giambattista
G
Derchi
Lorenzo
L
Ferraris
Romano
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000191:economics* / Q000379:methods*; D015179:Colorectal Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors