Follow-up after curative resection of colorectal cancer: a meta-analysis.
OBJECTIVE
This is a systematic review to evaluate the impact of various follow-up intensities and strategies on the outcome of patients after curative surgery for colorectal cancer.


METHODS
All randomized trials up to January 2007, comparing different follow-up intensities and strategies, were retrieved. Meta-analysis was performed by using the Forest plot review.


RESULTS
Eight randomized, clinical trials with 2,923 patients with colorectal cancer undergoing curative resection were reviewed. There was a significant reduction in overall mortality in patients having intensive follow-up (intensive vs. less intensive follow-up: 21.8 vs. 25.7 percent; P = 0.01). Regular surveillance with serum carcinoembryonic antigen (P = 0.0002) and colonoscopy (P = 0.04) demonstrated a significant impact on overall mortality. However, cancer-related mortality did not show any significant difference. There was no significant difference in all-site recurrence and in local or distant metastasis. Detection of isolated local and hepatic recurrences was similar. Intensive follow-up detected asymptomatic recurrence more frequently (18.9 vs. 6.3 percent; P < 0.00001) and 5.91 months earlier than less intensive follow-up protocol; these were demonstrated with all investigation strategies used. Intensive surveillance program detected recurrences that were significantly more amenable to surgical reresection (10.7 vs. 5.7 percent; P = 0.0002). The chance of curative reresection were significantly better with more intensive follow-up (24.3 vs. 9.9 percent; P = 0.0001), independent of the investigation strategies used.


CONCLUSIONS
Intensive follow-up after curative resection of colorectal cancer improved overall survival and reresection rate for recurrent disease. However, the cancer-related mortality was not improved and the survival benefit was not related to earlier detection and treatment of recurrent disease.
Tjandra
Joe J
JJ
Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Hospitals, University of Melbourne, Melbourne, Australia.
Chan
Miranda K Y
MK
D002272:Carcinoembryonic Antigen / Q000097:blood; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D003266:Continuity of Patient Care; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D016019:Survival Analysis
D002272:Carcinoembryonic Antigen