title: Intensive surveillance following curative treatment of colorectal cancer allows effective treatment of recurrence even if limited to 4 years.
abstract: BACKGROUND
  Current evidence suggests a survival benefit to post-operative surveillance following curative colorectal cancer resection; however, there is still no consensus on the optimal duration and form.
  
  
  OBJECTIVE
  The objective is to prospectively audit outcomes of an intensive colorectal cancer follow-up scheme for time to recurrence and survival.
  
  
  METHODS
  We used a surveillance protocol designed to incorporate regular clinical, biochemical, radiological and endoscopic measures at pre-defined intervals.
  
  
  METHODS
  The setting was a Department of Colorectal Surgery in a Tertiary Academic Centre. Follow-up was led by specially trained colorectal nurses in conjunction with surgeons.
  
  
  METHODS
  Consecutive patients who had undergone curative treatment for colorectal cancer were included in this study.
  
  
  RESULTS
  Outcomes were measured in terms of overall survival and disease recurrence.
  
  
  RESULTS
  There were 436 patients entered into follow-up, all treated with curative intent. Mean age 65.9 years (SD 12.9 years) and 240 male (55.0 %). Ninety-four patients (21.5 %) with stage I disease, 119 (27.3 %) stage IIa, 30 (6.9 %) stage IIb, 18 (4.1 %) stage IIIa, 78 (17.9 %) stage IIIb, 45 (10.4 %) stage IIIc and 52 (11.9 %) stage IV. Overall median survival was 37.5 months for all patients, (range 0.0-207.8 months). Ninety-two (21.1 %) cancer-related deaths were recorded during the course of the study. The overall 5-year actuarial cancer-related survival was 81.7 %. There was a 40.3 % 5-year actuarial survival was recorded in patients with 39 a recurrence, 57.7 % in patients treated with further curative 40 intent and 27.7 % in patients who received palliative treatment 41 (P < 0.001). Ninety-seven percent of recurrences were detected within 4 years of curative treatment.
  
  
  CONCLUSIONS
  This follow-up protocol confers an 81 % overall 5-year actuarial survival. Our study suggests that surveillance after curative resection can be limited to 4 years, which would lead to detection of over 97 % of all recurrences.
authors: Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK.
authors: Katie
authors: K
authors: Adams
authors: Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK.
authors: Lynne
authors: L
authors: Higgins
authors: Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK.
authors: Stella
authors: S
authors: Beazley
authors: Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK. spapagrigoriadis@nhs.net.
authors: Savvas
authors: S
authors: Papagrigoriadis
mesh_terms: D000359:Aftercare; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal cancer; Follow-up; Surveillance; Survival