Follow-up after curative surgery for colorectal carcinoma
Tóm tắt
PURPOSE: This study investigated the value of intense follow-up compared with no follow-up after curative surgery of cancer in the colon or rectum. METHODS: One hundred seven patients were randomized to no follow-up (control group; n=54) or intense follow-up (follow-up group; n=53) after surgery and early postoperative colonoscopy. Patients in the follow-up group were followed at frequent intervals with clinical examination, rigid proctosigmoidoscopy, colonoscopy, computed tomography of the pelvis (in patients operated with abdominoperineal resection), pulmonary x-ray, liver function tests, and determinations of carcinoembryonic antigen and fecal hemoglobin. Follow-up ranged from 5.5 to 8.8 years after primary surgery. RESULTS: Tumor recurred in 18 patients (33 percent) in the control group and in 17 patients (32 percent) in the follow-up group. Reresection with curative intent was performed in three patients in the control group and in five patients (four of whom were asymptomatic) in the follow-up group. In the follow-up group two asymptomatic patients with elevated carcinoembryonic antigen levels were disease-free three and five and one-half years after reresection and were the only patients apparently cured by reresection. No patient underwent surgery for metastatic disease in the liver or lungs. Symptomatic metachronous carcinoma was detected in one patient (control group) after three years. Five-year survival rate was 67 percent in the control group and 75 percent in the follow-up group (P >
0.05); the corresponding cancer-specific survival rates were 71 percent and 78 percent, respectively. CONCLUSION: Intense follow-up after resection of colorectal cancer did not prolong survival in this study.
Tài liệu tham khảo
Beart RW Jr, Metzger PP, O'Connell MJ, Schutt AJ. Post-operative screening of patients with adenocarcinoma of the colon. Dis Colon Rectum 1981;24:585–8.
Törnqvist A, Ekelund G, Leandoer L. The value of intensive follow-up after curative resection for colorectal carcinoma. Br J Surg 1982;69:725–8.
Safi F, Link KH, Beger HG. Is follow-up of colorectal cancer patients worthwhile? Dis Colon Rectum 1993;36:636–44.
Böhm B, Schwenk W, Hucke HP, Stock W. Does methodological long-term follow-up affect survival after curative reresection of colorectal carcinoma? Dis Colon Rectum 1993;36:280–6.
Boey J, Cheung HC, Lai CK, Wong J. A prospective evaluation of serum carcinoembryonic antigen (CEA) levels in the management of colorectal carcinoma. World J Surg 1984;8:279–86.
Deveney KE, Way LE. Follow-up of patients with colorectal cancer. Am J Surg 1984;148:717–22.
Sugarbaker PH, Gianola FJ, Dwyer A, Neuman NR. A simplified plan for follow-up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results. Surgery 1987;102:79–87.
Wanebo HJ, Llaneras M, Martin T, Kaiser D. Prospective monitoring trial for carcinoma of colon and rectum after surgical resection. Surg Gynecol Obstet 1989;169:479–87.
Kelly CJ, Daly JM. Colorectal cancer: principles of post-operative follow-up. Cancer 1992;70:1397–408.
Nava HR, Pagana TJ. Postoperative surveillance of colorectal carcinoma. Cancer 1982;49:1043–7.
Manson PN, Corman ML, Coller JA, Veidenheimer MC. Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience. Dis Colon Rectum 1976;19:219–24.
Vassilopoulos PP, Yoon JM, Ledesma EJ, Mittelman A. Treatment of recurrence of adenocarcinoma of the colon and rectum at the anastomotic site. Surg Gynecol Obstet 1981;152:777–80.
Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon or rectum. Cancer 1975;36:2251–70.
Törnqvist A, Ekelund G, Leandoer L. Early diagnosis of metachronous colorectal carcinoma. Aust N Z J Surg 1981;51:442–5.
Dowling K, Watne A, Foshag L, Vargish T. Management of nonfamilial adenomatous polyps and colon cancers. Surgery 1985;98:684–7.
Lovett E. Family studies in cancer of the colon and rectum. Br J Surg 1976;63:13–8.
Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992;326:653–7.
Sandler RS, Freund DA, Herbst CA Jr, Sandler DP. Cost effectiveness of postoperative carcinoembryonic antigen monitoring in colorectal cancer. Cancer 1984;53:193–8.
Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen C. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 1993;270:943–7.
Martin EW, Minton JP, Carey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 1985;202:310–7.
Minton JP, Hoehn IL, Gerber DM,et al. Results of a 400-patient carcinoembryonic antigen second look colorectal cancer study. Cancer 1985;55:1284–90.
Schneebaum S, Arnold MW, Young D,et al. Role of carcinoembryonic antigen in predicting resectability of recurrent colorectal cancer. Dis Colon Rectum 1993;36:810–5.
Russell AH, Tong DT, Dawson LE, Wisbeck W. Adenocarcinoma of the proximal colon: sites of initial dissemination and patterns of recurrence following surgery alone. Cancer 1984;53:360–7.
Willet CG, Tepper JE, Cohen AM, Orlow E, Welch CE. Failure patterns following curative resection of colonic carcinoma. Ann Surg 1984;200:685–90.
Devesa JM, Morales V, Enriques JM,et al. Colorectal cancer: the bases for a comprehensive follow-up. Dis Colon Rectum 1988;31:636–52.
Ohlsson B, Tranberg K-G, Lundstedt C, Ekberg H, Hederström E. Detection of hepatic metastases in colorectal cancer: a prospective study of laboratory and imaging methods. Eur J Surg 1993;159:275–81.
Charnley RM, Morris DL, Dennison AR, Amar SS, Hardcastle JD. Detection of colorectal liver metastases using intraoperative ultrasonography. Br J Surg 1991;78:45–8.
Bruinvels DJ, Stiggelbout AM, Kievit J, van Houlwelingen HC, Habbema JD, van der Velde CJ. Follow-up of patients with colorectal cancer: a meta-analysis. Ann Surg 1994;219:174–82.
Northover JM. Carcinoembryonic antigen and recurrent colorectal cancer. Br J Surg 1985;72(Suppl):S4:4–6.
Kronborg O, Fenger C, Deichgräber E, Hansen L. Follow-up after radical surgery for colorectal cancer: design of a randomized study. Scand J Gastroenterol 1988;149(Suppl):159–62.