title: Post-treatment surveillance of patients with colorectal cancer with surgically treated liver metastases.
abstract: BACKGROUND
  Little is known about current surveillance patterns after treatment of colorectal liver metastasis (CRLM) or whether the intensity of surveillance correlates with outcome. We sought to define current population-based patterns of surveillance and investigate whether intensity of surveillance impacted outcome.
  
  
  METHODS
  We queried the Surveillance, Epidemiology, and End Results-linked Medicare database for patients with CRLM diagnosed between 1991 and 2005 who underwent liver resection and/or tumor ablation. Frequency of post-treatment abdominal computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) was recorded for ≤ 5 years after treatment. The association between frequency of imaging with secondary interventions and long-term survival were analyzed.
  
  
  RESULTS
  We identified 1,739 patients with CRLM treated with surgery; median age was 73 years, and the majority were male (52.6%). CRLM treatment consisted of liver resection (61%), ablation (32%), or both simultaneously (6%). CT (97%) was utilized more often for post-treatment surveillance compared with MRI (7%) and PET (18%). A temporal trend was noted with more frequent surveillance imaging obtained in post-treatment year 1 (2.4 scans/year) versus year 5 (0.6 scans/year; P = .01); 66% of living patients had no imaging after 2 years. Frequency of surveillance imaging correlated with procedure type (total number of scans/5 years: resection, 5.0; ablation, 4.6; resection and ablation, 6.2; P = .01). Other factors associated with a greater frequency of surveillance included younger age at diagnosis, geographic location in the South, and CRLM directed surgery in 2000 through 2005 (all P < .05). Overall survival did not differ by intensity of surveillance imaging (3-4 scans/yr, 43 months vs 2 scans/yr, 57 months vs 1 scan/yr, 54 months; P = .08).
  
  
  CONCLUSIONS
  Marked heterogeneity exists in how often surveillance imaging is obtained after treatment of CRLM. Intensity of imaging does not affect time to second procedure or median survival duration. Surveillance guidelines for CRLM need to be refocused to provide the best value for healthcare resources.
authors.affiliation: Department of Surgery at Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Dodson
authors.forename: Skye C
authors.initials: SC
authors.lastname: Mayo
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
references.citation: Can J Surg. 1997 Apr;40(2):90-100
references.pmid: 9126121
references.citation: Eur J Surg Oncol. 2000 Jun;26(4):329-37
references.pmid: 10873351
references.citation: J Surg Res. 2012 Jul;176(1):141-6
references.pmid: 21962740
references.citation: Surgery. 2011 Aug;150(2):204-16
references.pmid: 21801959
references.citation: J Gastrointest Surg. 2012 Jan;16(1):121-8
references.pmid: 21972054
references.citation: J Am Coll Surg. 2010 May;210(5):755-64, 764-6
references.pmid: 20421045
references.citation: J Clin Oncol. 2013 Feb 10;31(5):631-40
references.pmid: 23295805
references.citation: BMJ. 2002 Apr 6;324(7341):813
references.pmid: 11934773
references.citation: J Gastrointest Surg. 2011 Jul;15(7):1168-72
references.pmid: 21557021
references.citation: Radiology. 2003 Apr;227(1):113-7
references.pmid: 12668743
references.citation: Dis Colon Rectum. 1995 Jun;38(6):619-26
references.pmid: 7774474
references.citation: J Clin Oncol. 2006 Jan 20;24(3):386-93
references.pmid: 16365182
references.citation: J Gen Intern Med. 1997 May;12(5):318-31
references.pmid: 9159703
references.citation: J Clin Oncol. 2000 Oct 15;18(20):3586-8
references.pmid: 11032600
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references.pmid: 12187163
references.citation: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references.pmid: 22237781
references.citation: Ann Surg. 2009 Sep;250(3):440-8
references.pmid: 19730175
references.citation: N Engl J Med. 2007 Nov 29;357(22):2277-84
references.pmid: 18046031
references.citation: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD002200
references.pmid: 17253476
references.citation: Eur J Surg Oncol. 2000 Jun;26(4):322-8
references.pmid: 10873350
references.citation: Radiology. 2005 Mar;234(3):824-32
references.pmid: 15681686
references.citation: World J Surg. 1982 Jan;6(1):32-45
references.pmid: 7090394
references.citation: Oncologist. 2008 Jan;13(1):51-64
references.pmid: 18245012
references.citation: JAMA. 2012 Jun 13;307(22):2400-9
references.pmid: 22692172
references.citation: Am J Clin Oncol. 2005 Feb;28(1):30-5
references.pmid: 15685032
references.citation: Br J Surg. 1997 May;84(5):666-9
references.pmid: 9171758
references.citation: Ann Oncol. 2005;16 Suppl 1:i20-1
references.pmid: 15888739
references.citation: J Gastrointest Surg. 1997 Sep-Oct;1(5):398-407
references.pmid: 17061331
references.citation: Dis Colon Rectum. 2004 Jun;47(6):807-17
references.pmid: 15108028
references.citation: HPB (Oxford). 2011 Nov;13(11):774-82
references.pmid: 21999590
references.citation: JAMA. 2010 Apr 28;303(16):1625-31
references.pmid: 20424253
references.citation: J Gastrointest Surg. 2009 Dec;13(12):2141-51
references.pmid: 19795176
references.citation: Med Care. 1998 Jan;36(1):8-27
references.pmid: 9431328