Efficacy, impact on survival and cost of intensive follow-up after curative resection for colorectal cancer Aim

Abstract

AIM OF THE STUDY: This retrospective study was aimed at establishing the efficacy, impact on survival and cost of an intensive follow-up program.

METHODS: Data from 790 patients who underwent resections for primary colorectal carcinoma were prospectively entered into a data-base. Four hundred fifty-six patients who had radical surgery were followed-up with a 5-year preestablished schedule. Median follow-up was 42 months (range 2-108).

RESULTS: Seventy-four adenomas, 7 metachronous carcinomas, 11 extra-colonic carcinomas and 96 recurrences (13 locoregional recurrences, 68 metastases and 15 cases of combined recurrences) were detected. Thirty-eight (39.6%) of 96 recurrences were amenable to salvage therapy and 23 relapses (24.0%) were radically resected.. The median survival of patients who had recurrences was 38 months. The 5-year overall survival was significantly better in patients underwent radical surgery than those who were not treated with curative resection (60.0% vs 7.5%, p<0.0001). Radical re-operations were performed in 2 (4.8%) of the 42 symptomatic patients and in 21 (38.9%) of the 54 cases with asymptomatic relapses. Median overall survival of patients with asymptomatic recurrences was significantly higher than those with syntomatic relapses (20 vs 6 months, p<0.0001). The follow-up program used showed an efficacy of 4.6% and led to an expense, based on the exclusive cost of the visits and tests included, of 2087,10 € for colonic cancer and 2519.90 € for rectal cancer.

CONCLUSIONS: Our intensive follow-up program after curative colorectal cancer surgery allowed to detect a quite large number of asymptomatic recurrences with a benefit in term of radical re-operation and overall survival.