title: Cost-effectiveness analysis of postoperative surveillance protocols following radical surgery for colorectal cancer.
abstract: BACKGROUND
  Up to 30-50% of patients who undergo radical surgery for colorectal cancer (CRC) develop tumor relapse. The aim of this study was to assess various surveillance protocols utilized in a tertiary referral hospital in Northern Italy.
  
  
  METHODS
  Data concerning 373 consecutive patients who underwent radical surgery for CRC between 1990 and 2006 and whose data had been entered into a prospective database were considered eligible for this study. The overall costs and the percentages of recurrence following the various surveillance protocols were calculated.
  
  
  RESULTS
  One hundred two (27.35%) of the patients suffered a recurrence after a mean of 17.6 (95% CI 13.9-21.1) months. The combination of physical examination, colonoscopy, thorax-abdominal computed tomography (CT) scan, and serum carcinoembryonic antigen (CEA) dosage was found to be the most cost/effective one to monitor stages I and II colon cancer; while physical examination, rigid sigmoidoscopy, thorax-abdominal CT scan, and serum CEA dosage were found to be the most cost/effective surveillance to monitor stages III and IV of colon cancer and rectal cancer.
  
  
  CONCLUSIONS
  Adherence to follow-up guidelines and early detection are vital factors affecting the curability of relapsed cancer in CRC patients who undergo surgery. The first five years after surgery was found to be the most risky period for recurrence. Cost/effectiveness analysis indicate that follow-up protocols should be tailored to the risk of recurrence with the aim of identifying relapse when the disease is at an asymptomatic, presumably more curable stage.
authors.affiliation: Dept. of Surgery and Gastroenterological Sciences, University of Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Di Cristofaro
authors.forename: M
authors.initials: M
authors.lastname: Scarpa
authors.forename: I
authors.initials: I
authors.lastname: Angriman
authors.forename: E
authors.initials: E
authors.lastname: Perissinotto
authors.forename: C
authors.initials: C
authors.lastname: Ruffolo
authors.forename: M
authors.initials: M
authors.lastname: Frego
authors.forename: F
authors.initials: F
authors.lastname: Erroi
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003110:Colonic Neoplasms / Q000191:economics / Q000601:surgery*; D003266:Continuity of Patient Care / Q000592:standards*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011182:Postoperative Care / Q000191:economics* / Q000592:standards*; D012004:Rectal Neoplasms / Q000191:economics / Q000601:surgery*; D013997:Time Factors