Effectiveness of follow upBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7272.1332 (Published 25 November 2000) Cite this as: BMJ 2000;321:1332
- Colin McArdle
Population based studies show that for rectal cancer the incidence of local recurrence after apparently curative resection is about 20%. Local recurrence after surgery for colon cancer is less common. The liver is the commonest site of distant spread, followed by the lungs; brain and bone metastases are relatively rare. Most recurrences are within 24 months of surgery.
Symptomatic recurrence of colorectal cancer is seldom amenable to curative surgery
Aim of follow up
Traditionally surgeons have reviewed their patients at regular intervals after apparently curative resection. Recent surveys, however, have highlighted the lack of consensus among surgeons about the optimal modality and intensity of follow up; surveillance strategies range from a single postoperative visit to lifelong surveillance. Enthusiasts believe that intensive follow up and early intervention will lead to a reduction in the number of deaths from colorectal cancer; others point to the fact that the value of follow up is unproved. With so many tests available and no consensus on their value, it is not surprising that individual clinicians have tended to devise their own protocols.
Aims of follow up
Early detection and treatment of recurrent disease
Detection of a second, or metachronous, tumour in the large bowel
Provision of psychological support and advice
Facilitation of audit
Results of meta-analysis
A meta-analysis in the mid-1990s did little to clarify the situation. The researchers evaluated the results of seven non-randomised studies (covering over 3000 subjects in total) that compared intensive follow up with minimal or no follow up. Clearly several potential biases could and did exist. In the intensive group, investigations included clinical examination, faecal occult blood testing, liver function tests, measurement of the carcinoembyronic antigen, sigmoidoscopy, and either colonoscopy or barium enema examination. Liver ultrasonography was performed in only three studies and even then infrequently. In the intensive group more asymptomatic recurrences were detected, more patients underwent “second look” laparotomy, …