Value of outpatient follow-up after curative surgery for carcinoma of the large bowel.

Cochrane, John; Williams, Jeff T.; Faber, Richard; Slack, W.W.

doi:10.1136/bmj.280.6214.593

Cited by 126 publications

(31 citation statements)

References 9 publications

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“…The results of treatment have imIntensive follow-up, leading to early detection and reproved little during the last 40 years.2 Although more section of recurrences, is advocated by many authors as than two thirds of patients with colorectal cancer un-a way to increase the survival of patients with colorectal cancer who are operated on "'curatively. "4'5 Other authors, however, criticize the use of extensive postoperative diagnostic tests because the investments of extra costs and time do not seem to lead to a better survival 2,[16][17][18][19][20][21][22][23] rate. '…”

Section: Discussionmentioning

confidence: 99%

Follow-Up of Patients with Colorectal Cancer A Meta-Analysis

et al. 1994

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ObjectiveThe authors sought to determine whether intensive follow-up improves 5-year survival rates in patients with colorectal cancer who were operated on for cure. Summary Background DataIntensive follow-up of patients with colorectal cancer is still controversial. The present uncertainty in regard to the value of intensive follow-up could be the result of the absence of prospective randomized studies comparing patients with and without follow-up. MethodsStudies comparing two follow-up programs of different intensities were identified in the medical literature and were aggregated in a meta-analysis using the "random effects method." Seven nonrandomized studies describing 3283 patients were analyzed. ResultsPatients with intensive follow-up did have 9% better 5-year survival rates than did those with minimal or no follow-up, only when intensive follow-up included carcinoembryonic antigen (CEA) assays. In addition, more asymptomatic recurrences were detected and more recurrences were resected in patients with intensive follow-up. ConclusionsThis meta-analysis indicated that intensive follow-up using CEA assays can identify treatable recurrences at a relatively early stage. Treatment of these recurrences appears to be associated with improved 5-year survival rates. However, not all intensive follow-up strategies will be equally effective. Follow-up may yield the best results if diagnostic tests are used only to detect those recurrences that can be operated on with curative intent and when follow-up is "individualized," according to patient characteristics.Colorectal cancer is the third most common neoplasm dergo primary tumor resection for cure, more than one in Western countries and the second leading cause of halfwill eventually die of their disease.

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Section: Discussionmentioning

confidence: 99%

Follow-Up of Patients with Colorectal Cancer A Meta-Analysis

et al. 1994

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“…Some authors have questioned the need for intensive follow-up, or even any surveillance, after surgery for colorectal cancer [65][66][67] . Major debate occurs amongst those advocating surveillance, in relation to how intensive it should be, stemming from conflicting results of numerous studies, many of which are non-randomized [62,68] .…”

Section: Meta-analysesmentioning

confidence: 99%

Surveillance of patients following surgery with curative intent for colorectal cancer

Gan

Wilson²,

Hollington³

2007

WJG

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Surveillance after resection of colorectal cancer with curative intent is an important component of postoperative care. Clinical review, imaging, colonoscopy, and cost to the community are among significant issues to consider in planning a surveillance regime. This review aims to identify the available evidence for the use of surveillance and its individual components. The literature pertaining to follow-up of patients following potentially curative surgery for colorectal cancer was reviewed in order to formulate a summary of the wide range of clinical practice. There is evidence of improved survival of patients undergoing more intense follow-up compared with those having minimal surveillance, with an estimated overall 5-year gain of up to 10%. The efficacy of individual components of follow-up regimes remains unclear, but an overall package of 'intensive' follow-up including clinical review, liver imaging, and colonoscopy appears to be of benefit. It is cost-effective and can be specialist or community-based.

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“…15 The value of intensive follow-up has been addressed by a number of studies which failed to show any real benefit for intensive follow-up over symptomatic follow-up. [16][17][18] Most of these studies were done before the advent of safe liver resection. This intervention has shown a quantifiable survival advantage and may, therefore, be the one area where earlier detection of recurrence may be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Hepatic resection for colorectal metastases – a national perspective

Heriot

Reynolds²,

Marks³

et al. 2004

Ann R Coll Surg Engl

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C olorectal cancer remains the second commonest cause of cancer-related mortality resulting in over 19,000 deaths each year in the UK.1 Approximately a quarter of these patients have liver metastases at presentation 2,3 and another 20% will develop liver metastases following apparently curative surgery. 4 The 5-year survival of patients with untreated liver metastases is less than 3%. 5-7Hepatic resection for colorectal metastases -a national perspective AG Heriot, J Reynolds, CG Marks, N Karanjia Department of General Surgery, Royal Surrey County Hospital, Guildford, UKBackground: Many consultant surgeons are uncertain about peri-operative assessment and postoperative follow-up of patients for colorectal liver metastases, and indications for referral for hepatic resection. The aim of this study was to assess the views the consultant surgeons who manage these patients. Methods: A postal questionnaire was sent to all consultant members of the Association of Coloproctology of Great Britain and Ireland and of the Association of Upper GastrointestinalSurgeons of Great Britain and Ireland. The questionnaire assessed current practice for preoperative assessment and follow-up of patients with colorectal malignancy and timing of and criteria for hepatic resection of metastases. Number of referrals/resections were also assessed. Results: The response rate was 47%. Half of the consultants held joint clinics with an oncologist and 89% assessed the liver for secondaries prior to colorectal resection. Ultrasound was used by 75%. Whilst 99% would consider referring a patient with a solitary liver metastasis for resection, only 62% would consider resection for more than 3 unilobar metastases. The majority (83%) thought resections should be performed within the 6 months following colorectal resection. During follow-up, 52% requested blood CEA levels and 72% liver ultrasound. Half would consider chemotherapy prior to liver resection and 76% performed at least one hepatic resection per year with a median number of 2 resections each year. Conclusions: A substantial proportion of patients are assessed for colorectal liver metastases preoperatively and during follow-up though there is spectrum of frequency of assessment and modality for imaging. Virtually all patients with solitary hepatic metastases are considered for liver resection. Patients with more than one metastasis are likely to be not considered for resection. Many surgeons are carrying out less than 3 resections each year. Original article Hepatic resection for colorectal liver metastases has been shown to provide a significant survival benefit with 5-year survival approaching 40%, with an operative mortality of less than 5%. [8][9][10][11][12] The indications for resection of colorectal metastases have been extended over the last decade. Whilst some studies have shown that multiple metastases are a predictor of a less favourable outcome, 12 other studies have demonstrated that the outcome can still be satisfactory provided all the disease is resected. 8,9,13 Thus mu...

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Value of outpatient follow-up after curative surgery for carcinoma of the large bowel.

Cited by 126 publications

References 9 publications

Follow-Up of Patients with Colorectal Cancer A Meta-Analysis

Follow-Up of Patients with Colorectal Cancer A Meta-Analysis

Surveillance of patients following surgery with curative intent for colorectal cancer

Hepatic resection for colorectal metastases – a national perspective

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