Patient surveillance after curative-intent surgery for rectal cancer

Abstract

3661 Background: Follow-up of patients with rectal cancer after potentially curative primary therapy has significant financial and clinical implications for patients and society. The ideal monitoring regimen is unknown. Methods: We evaluated the self-reported practice patterns of a large group of experts. The 1,795 members of the American Society of Colon and Rectal Surgeons (ASCRS) were asked, via a detailed questionnaire, how often they request 14 discrete follow-up modalities (office visit, serum CEA level, CBC, liver function tests, sigmoidoscopy, colonoscopy, chest x-ray, intra-rectal ultrasound, abdomen/pelvis CT, chest CT, abdomen/pelvis MRI, positron-emission tomography, bone scan, and CEA scan) in their patients treated for cure with TNM stage I, II, or III rectal cancer over the first 5 post-treatment years. Results: Thirteen envelopes were returned unopened; 566 of the remaining 1,782 ASCRS members (32%) responded and 347 of these (61%) provided evaluable data. Members of the ASCRS often follow their own patients post-operatively rather than delegating this to others. Office visit is the most frequently requested item for each of the first 5 post-operative years (mean ± SD = 3.8 ± 2.7 visits in post-operative year 1 after radical surgery for stage I lesions, diminishing to 1.5 ± 1.0 visits in year 5). Colonoscopy is requested 0.9 ± 0.7 times in year 1 and 0.5 ± 0.7 times in year 5. Strategies for patients with stage II and III lesions are similar to those for stage I lesions. Conclusions: There is substantial variation in follow-up intensity among these experts. The reported surveillance strategies rely most heavily on relatively simple and inexpensive tests, but endoscopy and imaging modalities are also used regularly. The observed variation in the intensity of post-operative monitoring is of concern; investigation of the source(s) of this variation is warranted. No significant financial relationships to disclose.