Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials

doi:10.1136/bmj.324.7341.813

BMJ 2002;324:813 ( 6 April )

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Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials

Andrew G Renehan, senior research fellow, ^a Matthias Egger, professor in epidemiology and public health medicine, ^b Mark P Saunders, consultant clinical oncologist, ^c Sarah T O'Dwyer, consultant surgeon. ^a

^a Department of Surgery, Christie Hospital NHS Trust, Manchester M20 4BX, ^b MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^c Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester

Correspondence to: A Renehan arenehan{at}picr.man.ac.uk

Objective: To review the evidence from clinical trialsof follow up of patients after curative resection for colorectalcancer.
Design: Systematic review and meta-analysis of randomisedcontrolled trials of intensive compared with control followup.
Main outcome measures: All cause mortality at five years (primaryoutcome). Rates of recurrence of intraluminal, local, and metastaticdisease and metachronous (second colorectal primary) cancers (secondaryoutcomes).
Results: Five trials, which included 1342 patients,met the inclusion criteria. Intensive follow up was associatedwith a reduction in all cause mortality (combined risk ratio 0.81,95% confidence interval 0.70 to 0.94, P=0.007). The effect wasmost pronounced in the four extramural detection trials that usedcomputed tomography and frequent measurements of serum carcinoembryonicantigen (risk ratio 0.73, 0.60 to 0.89, P=0.002). Intensive followup was associated with significantly earlier detection of allrecurrences (difference in means 8.5 months, 7.6 to 9.4 months,P<0.001) and an increased detection rate for isolated local recurrences(risk ratio 1.61, 1.12 to 2.32, P=0.011).
Conclusions: Intensive follow up after curative resectionfor colorectal cancer improves survival. Large trials are requiredto identify which components of intensive follow up are mostbeneficial.

What is already known on this topic
There is a lack of direct evidence that intensive follow up after initial curative treatment for colorectal cancer leads to increased survival

Guidelines are inconclusive and clinical practice varies widely

What this study adds
The cumulative analysis of available data supports the view that intensive follow up after curative resection for colorectal cancer improves survival

If computed tomography and frequent measurements of serum carcinoembryonic antigen are used during follow up mortality related to cancer is reduced by 9-13%

This survival benefit is partly attributable to the earlier detection of all recurrences, particularly the increased detection of isolated recurrent disease

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Rapid Responses:

Read all Rapid Responses

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bmj.com, 10 Apr 2002 [Full text]
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Authors' response: Andrew G. Renehan, et al.
bmj.com, 2 Jul 2002 [Full text]