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  • Review Article
  • Published:

Surveillance after curative treatment for colorectal cancer

Nature Reviews Clinical Oncology volume 14, pages 297–315 (2017)Cite this article

Subjects

Key Points

  • Pooled analyses of prospective trials have demonstrated an overall survival benefit of intensive postoperative surveillance in patients with stage I–III colorectal cancer (CRC); however, individual studies used highly heterogeneous surveillance schemes

  • The overall survival benefit of intensive surveillance is only partly due to improved cancer-specific survival; other contributing factors include the treatment of comorbidities owing to frequent contact with medical professionals

  • For patients with stage I–III CRC, no optimal diagnostic tool or frequency of patient visits has been established; regular follow-up assessment by a clinician seem to be the most-important factor

  • Colonoscopies are generally performed at 6, 30 and 60 months after curative treatment of patients with stage I–III CRC; performing additional colonoscopies does not improve overall survival

  • Limited evidence is available regarding surveillance after endoscopic resection of early neoplasia, and after organ-sparing treatment for rectal cancer; prospective randomized trials are needed

  • Similarly, a lack of evidence exists on the effectiveness of surveillance after treatment of patients with stage IV CRC with curative intent, and thus randomized trials are also needed to address this issue

Abstract

Treatments for colorectal cancer (CRC) of all stages have evolved considerably over the past two decades, resulting in improved long-term outcomes. After curative treatment, however, 30% of patients with stage I–III and up to 65% of patients with stage IV CRC develop recurrent disease. Thus, patients are routinely offered surveillance in order to detect disease recurrence at an early, asymptomatic stage, with the intention of improving survival. Nevertheless, controversy continues to surround the optimal surveillance protocols. For patients with stage I–III CRC, more-intensive surveillance improves overall survival compared with less-intensive or no surveillance, probably owing to improved outcomes after cancer recurrence, as well as proactive treatment of other conditions detected opportunistically. The benefit of surveillance after curative treatment of stage IV CRC is more controversial, but might be justified because repeat resection can improve overall survival and 20% of these patients are eligible for such treatment with curative intent. No trials have assessed the optimal follow-up approach after curative resection of metastatic CRC, and similarly to surveillance of patients with stage I–III disease, most programmes are more intensive during the first 3 years than at later time points. Herein, we provide a comprehensive overview of surveillance strategies for patients with CRC, and discuss the future development of patient-centred programmes.

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Figure 1: CT imaging surveillance for the diagnosis of colorectal liver metastases.
Figure 2: PET–CT imaging surveillance for the diagnosis of pulmonary metastases.
Figure 3: Resection of colorectal liver metastases.

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Authors and Affiliations

  1. Department of Surgical Oncology, Erasmus MC University Medical Center. Erasmus MC Cancer Institute, Groene Hilledijk 301, Rotterdam, 3075 EA, Netherlands

    Eric P. van der Stok, Dirk J. Grünhagen & Cornelis Verhoef

  2. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, Netherlands

    Manon C. W. Spaander & Ernst J. Kuipers

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E.P.v.d.S., C.V. and E.J.K. researched the data for article. All authors contributed substantially to discussions of content. E.P.v.d.S., C.V. and E.J.K. wrote the manuscript. M.C.W.S., D.J.G., C.V., and E.J.K. reviewed/edited the manuscript before submission.

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van der Stok, E., Spaander, M., Grünhagen, D. et al. Surveillance after curative treatment for colorectal cancer. Nat Rev Clin Oncol 14, 297–315 (2017). https://doi.org/10.1038/nrclinonc.2016.199

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