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Evidence summaries

Follow-Up Strategies for Patients Treated for Non-Metastatic Colorectal Cancer

There is no overall survival benefit for intensifying the follow-up of patients after curative surgery for colorectal cancer, but the best combination and frequency of visits to doctor, blood tests, endoscopic procedures, and radiological investigations remains to be determined. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 19 studies with a total of 13 216 subjects. The studies varied in setting (GP-led, nurse-led, or surgeon-led) and "intensity" of follow-up.

Overall survival: no evidence of a statistical effect with intensive follow-up was found (HR 0.93, 95% CI 0.80 to 1.04). There were 1453 deaths among 12528 participants enrolled in 15 studies.

Colorectal cancer-specific survival: no difference was found with intensive follow-up (HR 0.93, 95% CI 0.78 to 1.07). There were 925 colorectal cancer deaths among 11 771 participants enrolled in 11 studies.

Relapse-free survival: no statistical evidence was found of effect with intensive follow-up (HR 1.05, 95% CI 0.92 to 1.21). There were 2254 relapses among 8047 participants enrolled in 16 studies.

Salvage surgery with curative intent: this was more frequent with intensive follow-up (RR 1.98, 95% CI 1.53 to 2.56). There were 457 episodes of salvage surgery in 5157 participants enrolled in 13 studies.

Interval (symptomatic) recurrences: these were less frequent with intensive follow-up (RR 0.59, 95% CI 0.41 to 0.86). 376 interval recurrences were reported in 3933 participants enrolled in seven studies.

Intensive follow-up did not appear to affect quality of life, anxiety, nor depression (reported in three studies).Intensive follow-up may increase the complications (perforation or haemorrhage) from colonoscopies (OR 7.30, 95% CI 0.75 to 70.69; 1 study, 326 participants). In two studies, there were seven colonoscopic complications in 2112 colonoscopies.

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References

  • Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2019;(9):CD002200. [PubMed]

Primary/Secondary Keywords