Follow-up after curative resection of colorectal cancer: a meta-analysis.
Dis Colon Rectum
; 50(11): 1783-99, 2007 Nov.
Article
in En
| MEDLINE
| ID: mdl-17874269
ABSTRACT
PURPOSE:
This is a systematic review to evaluate the impact of various follow-up intensities and strategies on the outcome of patients after curative surgery for colorectal cancer.METHODS:
All randomized trials up to January 2007, comparing different follow-up intensities and strategies, were retrieved. Meta-analysis was performed by using the Forest plot review.RESULTS:
Eight randomized, clinical trials with 2,923 patients with colorectal cancer undergoing curative resection were reviewed. There was a significant reduction in overall mortality in patients having intensive follow-up (intensive vs. less intensive follow-up 21.8 vs. 25.7 percent; P = 0.01). Regular surveillance with serum carcinoembryonic antigen (P = 0.0002) and colonoscopy (P = 0.04) demonstrated a significant impact on overall mortality. However, cancer-related mortality did not show any significant difference. There was no significant difference in all-site recurrence and in local or distant metastasis. Detection of isolated local and hepatic recurrences was similar. Intensive follow-up detected asymptomatic recurrence more frequently (18.9 vs. 6.3 percent; P < 0.00001) and 5.91 months earlier than less intensive follow-up protocol; these were demonstrated with all investigation strategies used. Intensive surveillance program detected recurrences that were significantly more amenable to surgical reresection (10.7 vs. 5.7 percent; P = 0.0002). The chance of curative reresection were significantly better with more intensive follow-up (24.3 vs. 9.9 percent; P = 0.0001), independent of the investigation strategies used.CONCLUSIONS:
Intensive follow-up after curative resection of colorectal cancer improved overall survival and reresection rate for recurrent disease. However, the cancer-related mortality was not improved and the survival benefit was not related to earlier detection and treatment of recurrent disease.
Search on Google
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Outcome and Process Assessment, Health Care
/
Colorectal Neoplasms
/
Continuity of Patient Care
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Guideline
/
Prognostic_studies
/
Systematic_reviews
Aspects:
Patient_preference
Limits:
Humans
Language:
En
Journal:
Dis Colon Rectum
Year:
2007
Document type:
Article
Affiliation country:
Australia