The patient

A 59 year old woman had an anterior resection for primary Dukes's C rectal carcinoma in 2004 followed by adjuvant chemotherapy. Two years later, on routine computed tomography surveillance, she was found to have liver (fig 1⇓) and lung (fig 2⇓) metastases.

Imaging for surveillance after resection of primary colorectal cancer

Surveillance is indicated in patients with Dukes's B or Dukes's C colorectal carcinoma who are potential candidates for further therapeutic intervention. The optimal surveillance strategy is a matter of debate.1 2 3 An ongoing trial (FACS) is looking at the cost effectiveness of intensive follow-up or no follow-up in patients with successfully resected colorectal cancer (www.facs.soton.ac.uk/). Currently, most centres opt for computed tomography scans at six or 12 monthly intervals for the first two or three years, combined with regular measurements of serum carcinoembryonic antigen.

Because the liver metastases were centrally located in our patient, surgery would have involved removal of three quarters of the liver, followed by pulmonary lobectomy for the lung metastasis. Liver resection and pulmonary resection are associated with a small increase in mortality—less than 5% for …