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Meta-Analysis of Intensive Follow-Up After Curative Resection for Colorectal Cancer

Results of this meta-analysis suggest that intensive follow-up after curative resection for colorectal cancer improves survival.

Surveillance regimens after curative resection for colorectal cancer in clinical practice vary widely. Further, guidelines are inconsistent and clinical trials have not provided definitive evidence that intensive follow-up improves survival. Researchers performed a meta-analysis of data from 5 randomized controlled trials (1342 participants) in which intensive and control follow-up regimens were compared after curative resection for colorectal cancer. Intensive surveillance protocols involved varied use of colonoscopy, carcinoembryonic antigen (CEA) testing, liver imaging, and chest X-ray.

The risk ratio for all-cause mortality in the intensive-surveillance group was 0.81 (95% CI, 0.70-0.94). The effect on mortality was most pronounced in the 4 trials in which computed tomography and frequent serum CEA measurements were used (RR, 0.73; CI, 0.60-0.89). Intensive follow-up was associated with earlier detection of recurrence (mean, 8.5 months earlier) and increased detection rate of isolated local recurrence (RR, 1.61; CI, 1.12-2.32). Overall rates of intraluminal recurrence and detection of metachronous cancer were low (3.2% and 1.3%, respectively), and there were no differences between follow-up regimens.

Comment: The results of this meta-analysis challenge the results of single smaller studies and of previous meta-analyses that included retrospective studies. The data suggest that intensive follow-up after curative resection for colorectal cancer improves survival and that intensive surveillance should be focused on detection of extramural recurrence by CEA and computed tomography and not on detection of intraluminal recurrence by colonoscopy. The cost of intensive surveillance per life-year saved was not calculated.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology July 2, 2002

Citation(s):

Renehan AG et al. Impact on survival of intensive follow up after curative resection for colorectal cancer: Systematic review and meta-analysis of randomised trials. BMJ 2002 Apr 6; 324:813-6.

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