Advertisement

Is follow-up still mandatory more than 5 years after surgery for colorectal cancer?

  • Alice Frontali
  • Benjamin Benichou
  • Ionut Valcea
  • Léon Maggiori
  • Justine Prost à la Denise
  • Yves PanisEmail author
Original Article
  • 24 Downloads

Abstract

Purpose

The aim of this study was to assess if to prolong follow-up (FU) more than 5 years after surgery for colorectal cancer (CRC) is justified or not.

Methods

Patients who underwent surgery for a CRC before 2013 and without any tumor recurrence (or synchronous metastases) during the first 5 years after surgery were identified from our database and included.

Results

Between 1996 and 2012, 121 patients operated for rectal (RC) (median of FU of 84 months; range 60–211) and 97 with colonic cancer (CC) (median of FU of 78 months; range 60–139), without any tumor recurrence (or synchronous metastases) during the first 5 years after surgery, presented a late tumor recurrence: 13/121 RC (10.7%) versus 2/97 CC (2.1%) (p = 0.014); 8/13 recurrences in RC (61.5%) were observed after neoadjuvant radiochemotherapy, and 9/13 (69.2%) in pN0 tumors. Among the 13 recurrences, 3 had both local and metastatic recurrences (23%), 5 an isolated local recurrence (38.5%) and 5 an isolated metastatic recurrence (38.5%). After surgery for CC, the 2 recurrences were observed in patients with T3N0 tumors.

Conclusion

After surgery for a CRC, in patients without tumor recurrence during the first 5 years after surgery, follow-up after 5 years must be continued in rectal cancer patients because of a 10.7% rate of late recurrence. On the opposite, after surgery for colon cancer the 2% rate of late recurrence after 5 years suggested that only patients with pT3–T4 colonic cancer could probably be followed more than 5 years after surgery.

Keywords

Colorectal cancer Tumor recurrence Surgery Follow-up program 

Notes

Compliance with ethical standards

Conflict of interest

None.

Research involving human participants and/or animals

This study was conducted according to the ethical standards of the Committee on Human Experimentation, and data were collected anonymously approved by the Ethics Committee of our Institution. This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Steele SR, Chang GJ, Hendren S, Weiser M, Irani J, Buie WD et al (2015) Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Dis Colon Rectum 58:713–725CrossRefGoogle Scholar
  2. 2.
    Gérard JP, André T, Bibeau F, Conroy T, Legoux JL, Portier G et al (2017) Rectal cancer: French Intergroup clinical practice guidelines for diagnosis, treatments and follow-up. Dig Liver Dis 49:359–367CrossRefGoogle Scholar
  3. 3.
    Lecomte T, André T, Panis Y, Laurent-Puig P, Bibeau F, Taieb J (2016) Cancer du côlon. Thésaurus National de Cancérologie Digestive, 11. http://www.tncd.org
  4. 4.
    Arezzo A, Bianco F, Agresta F, Coco C, Faletti R, Krivocapic Z et al (2015) Practice parameters for early rectal cancer management: Italian Society of Colorectal Surgery (SICCR) guidelines. Tech Coloproctol 19:587–593CrossRefGoogle Scholar
  5. 5.
    Bianco F, Arezzo A, Agresta F, Coco C, Faletti R, Krivocapic Z et al (2015) Practice parameters for early colon cancer Italian Society of Colorectal Surgery (SICCR) guidelines. Tech Coloproctol 19:577–585CrossRefGoogle Scholar
  6. 6.
    Deijen CL, Vasmel JE, de Lange-de Klerk ESM, Cuesta MA, Coene PPLO, Lange JF et al (2017) Ten-year outcomes of a randomized trial of laparoscopic versus open surgery for colon cancer. Surg Endosc 31:2607–2615CrossRefGoogle Scholar
  7. 7.
    Debove C, Maggiori L, Chau A, Kanso F, Ferron M, Panis Y (2015) What happens after R1 resection in patients undergoing laparoscopic total mesorectal excision for rectal cancer? A study in 333 consecutive patients. Colorectal Dis 17:197–204CrossRefGoogle Scholar
  8. 8.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457CrossRefGoogle Scholar
  9. 9.
    Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7CrossRefGoogle Scholar
  10. 10.
    Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82CrossRefGoogle Scholar
  11. 11.
    Cho YB, Chun HK, Yun HR, Lee WS, Yun SH, Lee WY (2007) Clinical and pathologic evaluation of patients with recurrence of colorectal cancer five or more years after curative resection. Dis Colon Rectum 50:1–7CrossRefGoogle Scholar
  12. 12.
    Daniels AM, Vogelaar JFJ (2017) Late onset pulmonary metastasis more than 10 years after primary sigmoid carcinoma. World J Gastrointest Pathophysiol 15:96–99CrossRefGoogle Scholar
  13. 13.
    Merkel S, Meyer T, Göhl J, Hohenberger W (2002) Late locoregional recurrence in rectal carcinoma. EJSO 28:716–722CrossRefGoogle Scholar
  14. 14.
    Merkel S, Mansmann U, Hohenberger W, Hermanek P (2011) Time to locoregional recurrence after curative resection of rectal carcinoma is prolonged after neoadjuvant treatment: a systematic review and meta-analysis. Colorectal Dis 13:123–131CrossRefGoogle Scholar
  15. 15.
    Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W et al (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241:829–838CrossRefGoogle Scholar
  16. 16.
    Westberg K, Palmer G, Johansson H, Holm T, Martling A (2015) Time to local recurrence as a prognostic factor in patients with rectal cancer. EJSO 41:659–666CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.Service de Chirurgie Colorectale, Pôle des Maladies de l’Appareil Digestif (PMAD), Hôpital Beaujon–Assistance Publique des Hôpitaux de Paris (APHP)Université Paris VII (Denis Diderot)ClichyFrance

Personalised recommendations