Intensive surveillance following curative treatment of colorectal cancer allows effective treatment of recurrence even if limited to 4 years.

Abstract

Current evidence suggests a survival benefit to post-operative surveillance following curative colorectal cancer resection; however, there is still no consensus on the optimal duration and form. The objective is to prospectively audit outcomes of an intensive colorectal cancer follow-up scheme for time to recurrence and survival. We used a surveillance protocol designed to incorporate regular clinical, biochemical, radiological and endoscopic measures at pre-defined intervals. The setting was a Department of Colorectal Surgery in a Tertiary Academic Centre. Follow-up was led by specially trained colorectal nurses in conjunction with surgeons. Consecutive patients who had undergone curative treatment for colorectal cancer were included in this study. Outcomes were measured in terms of overall survival and disease recurrence. There were 436 patients entered into follow-up, all treated with curative intent. Mean age 65.9 years (SD 12.9 years) and 240 male (55.0 %). Ninety-four patients (21.5 %) with stage I disease, 119 (27.3 %) stage IIa, 30 (6.9 %) stage IIb, 18 (4.1 %) stage IIIa, 78 (17.9 %) stage IIIb, 45 (10.4 %) stage IIIc and 52 (11.9 %) stage IV. Overall median survival was 37.5 months for all patients, (range 0.0-207.8 months). Ninety-two (21.1 %) cancer-related deaths were recorded during the course of the study. The overall 5-year actuarial cancer-related survival was 81.7 %. There was a 40.3 % 5-year actuarial survival was recorded in patients with 39 a recurrence, 57.7 % in patients treated with further curative 40 intent and 27.7 % in patients who received palliative treatment 41 (P < 0.001). Ninety-seven percent of recurrences were detected within 4 years of curative treatment. This follow-up protocol confers an 81 % overall 5-year actuarial survival. Our study suggests that surveillance after curative resection can be limited to 4 years, which would lead to detection of over 97 % of all recurrences.