title: Clinical follow-up does not improve survival after resection of stage I-III colorectal cancer: A cohort study.
abstract: BACKGROUND
  The benefit of clinical follow-up alongside CT & CEA in detecting recurrent colorectal cancer (CRC) remains unclear. Despite this, clinical review remains part of most surveillance protocols. This study assessed the efficacy of clinical follow-up in addition to CT/CEA in detecting disease recurrence.
  
  
  METHODS
  Patients undergoing surgery for CRC at a single centre between 2009 and 2011 were identified. Follow-up included clinical review, CT and CEA for 5 years. The primary endpoint of the study was method of detection of recurrence. Secondary endpoints included detection of surgically treatable recurrence, compliance with follow-up, disease free survival and overall survival.
  
  
  RESULTS
  118 patients with stage I-III CRC were included. Only 68.9% of scheduled follow-up events were performed (76.6% clinical reviews, 76.2% CT scans and 60.4% CEA tests). At median follow-up of 36 months, 26 patients had developed recurrence (median DFS 45.8 months). 17 patients (14.7%) had died (median OS 49.3 months). Sensitivity and specificity of follow up modality in detecting recurrence were; CT (92.3%, 100%), CEA (57.7%, 100%), clinical review (23.0%, 27.2%). Addition of clinical review did not identify any disease recurrence that was not detected by scheduled CT. Eight patients (30.7%) had surgically treatable recurrence - all were identified by scheduled CT.
  
  
  CONCLUSIONS
  The addition of CEA testing and clinical review to scheduled CT scanning offered no benefit in the detection of recurrent disease. Clinical review could be removed from follow-up protocols without any reduction in the detection of recurrent cancer.
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Colorectal Surgery, Mid Cheshire Hospitals Foundation Trust, Crewe, UK. Electronic address: robjones@liv.ac.uk.
authors.forename: R P
authors.initials: RP
authors.lastname: Jones
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Colorectal Surgery, Mid Cheshire Hospitals Foundation Trust, Crewe, UK.
authors.forename: D
authors.initials: D
authors.lastname: McWhirter
authors.affiliation: Department of Colorectal Surgery, Mid Cheshire Hospitals Foundation Trust, Crewe, UK.
authors.forename: V L
authors.initials: VL
authors.lastname: Fretwell
authors.affiliation: Department of Colorectal Surgery, Mid Cheshire Hospitals Foundation Trust, Crewe, UK.
authors.forename: A
authors.initials: A
authors.lastname: McAvoy
authors.affiliation: Department of Colorectal Surgery, Mid Cheshire Hospitals Foundation Trust, Crewe, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Hardman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality*; D009367:Neoplasm Staging; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Cancer; Colorectal; Follow up; Recurrence