Background
Site of Recurrence | Percent of Patients with Recurrence at 5 Years by Site of Initial Tumoura
| Screening Tests | |
---|---|---|---|
Colon | Rectum | ||
Liver | 35 | 30 | CEA, US or CT, RIS?, Sx |
Lung | 20 | 30 | Chest x-ray, CEA, Sx |
Peritoneal | 20 | 20 | CEA, Sx, CT, RIS? |
Retroperitoneal | 15 | 5b
| CEA, CT, RIS?, Sx |
Peripheral Lymph Nodes | 2 | 7b
| Physical exam, CEA |
Other (brain, bones) | <5 | <5 | Sx, scans |
Loco-regional | 15 | 35b
| CT pelvis, CEA, RIS? Sx, endoscopy? FOB? |
Second or metachronous colorectal cancer | 3 | 3 | Colonoscopy, FOB? |
Methods
Examination Of The Evidence
Literature Search Strategy
Study Selection Criteria
Synthesizing the Evidence
Results
Literature Search Results
Trials [Reference] | Follow-up programs compared | CEA testing used | Liver Imaging testing used |
---|---|---|---|
Makela [36] | Intense vs. Conventional | Yes | Yes |
Ohlsson [37] | Intense vs. Minimal | Yes | No |
Kjeldsen [38] | Intense vs. Minimal | No | No |
Schoemaker [39] | Intense vs. Minimal | No* | Yes |
Pietra [40] | Intense vs. Conventional | Yes | Yes |
Secco [41] | Intense vs. Minimal | Yes | Yes |
Quality of trial reporting
Population investigated
Outcomes
Randomized Trials
Study [Reference] | Location (Years) | Follow-up Program | |
---|---|---|---|
Control | Intervention | ||
Makela [36] | Finland (1988–90) | Regular (n = 54): Clinical assessment, blood counts and CEA, chest x-ray, and fecal occult blood (FOB) every 3 months for 2 years, then every 6 months for next 3 years; rigid sigmoidoscopy for rectosigmoid tumours at each visit, and yearly barium enema for all patients. | Intensive (n = 52): Clinical assessment, blood counts and CEA, chest x-ray and FOB as in regular follow-up program. In addition, colonoscopy at 3 months if not performed preoperatively and then yearly thereafter on all patients, flexible sigmoidoscopy for rectosigmoid tumors every 3 months, liver ultrasound every 6 months, and yearly CT of liver and site of operation. |
Ohlsson [37] | Sweden (1983–86) | Minimal (n = 54): FOB every 3 months for 2 years, then yearly, and to consult for a list of symptoms. | Regular (n = 53): Clinical assessments, blood CEA and liver enzyme, chest x-ray, FOB and rigid sigmoidoscopy every 3 months for 2 years, then every 6 months; endoscopy control of anastomosis by flexible endoscopy at 9, 21, and 42 months; complete colonoscopy at 3, 15, 30, and 60 months; CT of pelvis (if they had abdominoperineal resection) at 3,6,12, 18, and 24 months. |
Kjeldsen [38] | Denmark (1985–94) | Minimal (n = 307): Clinical assessment, blood hemoglobin, sedimentation rate and liver enzymes, chest x-ray, FOB, and colonoscopy (if incomplete, double contrast barium enema) at 5, 10, and 15 years. | Regular (n = 290): Same tests as minimal follow-up program, but tests were conducted every 6 months for 3 years, and then at 4, 5, 7.5, 10, 12.5, and 15 years. |
Schoemaker [39] | Australia (1984–90) | Minimal (n = 158): Clinical assessment, blood counts, CEA, liver function tests and FOB every 3 months for 2 years, then every 6 months for 5 years; chest x-rays, liver CT scan and colonoscopy at 5 years. | Regular (n = 167): Clinical assessment, blood counts, CEA, liver function tests and FOB as in regular follow-up program. In addition, chest x-rays, liver CT scan and colonoscopy annually. Isolated increase in CEA levels did not trigger further investigations. |
Pietra [40] | Italy (1987–90) | Regular (n = 103) Clinical assessment, CEA, and liver ultrasound every 6 months for one year, then yearly; chest x-ray and colonoscopy yearly. | Intensive (n = 104) Clinical assessment, CEA, and liver ultrasound as regular follow-up program, but tests conducted every 3 months for 2 years, then every 6 months for 3 years, and yearly thereafter. In addition, chest x-ray, abdominal CT and colonoscopy yearly. |
Secco [41] | Italy (1988–96) | Minimal (n = 145) Patients to phone the surgical team every 6 months. Clinical assessment by family physician at least once a year or when suggestive symptoms of recurrence occurred. | Intensive (n= 192) High Risk Patients: Clinical assessment and CEA every 3 months for 2 years, every 4 months in the third year and every 6 months in years 4 and 5. Abdominal and pelvic ultrasound performed every 6 months the first 3 years and yearly in years 4 and 5. Rigid recto-sigmoidoscopy and chest x-ray yearly for patients with rectal cancer. Low Risk Patients: Clinical assessment and CEA every 6 months for 2 years, then yearly; abdominal and pelvic ultrasound every 6 months for 2 years, then once a year. Rigid recto-sigmoidoscopy for rectal cancer yearly twice, then every 2 years and chest x-ray yearly. |
Study, Year [Reference] | Follow-up Program intensity | Number of Patients Randomized | Median Observation (months) | Overall Recurrence Rate (%) | Number of Second Bowel Cancers | Radical Reoperation Rate (%) | 5-year Survival Rate (%) |
---|---|---|---|---|---|---|---|
Makela 1995 [36] | Less More | 54 52 | >60 | 39 42 | NR | 14 23 | 54 59 |
Ohlsson 1995 [37] | Less More | 54 53 | 82 | 33 32 | NR | 17 29 | 67 75 |
Kjeldsen 1997 [38] | Less More | 307 290 | >60 | 26 26 | 3 7 | NR | 68 70 |
Schoemaker 1998 [39] | Less More | 158 167 | >60 | NR | 5 3 | NR | 70 76 |
Pietra 1998 [40] | Less More | 103 104 | >60 | 19 25a
| 1 0 | 10 65 | 58 73b
|
Secco 2002 [41] | Less More | 145 192 | >60 | 53 57 | NR | 16 31 | 48 63 |