Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial

J. T. Makela, S. O. Laitinen and M. I. Kairaluoma
Department of Surgery, Oulu University Hospital, Finland.

OBJECTIVE: To determine whether an intensified follow-up of patients with colorectal cancer can lead to improved reresectability and a better long-term survival. DESIGN: A prospective randomized trial of 106 patients. SETTING: Oulu University Hospital, a referral center in northern Finland. PATIENTS: A total of 106 consecutive patients who underwent radical resection for colorectal cancer, 54 of whom were randomized into a conventional follow-up group and 52 into an intensified follow-up group. MAIN OUTCOME MEASURES: After a 5-year follow-up, the time of detection of recurrence, the recurrence rates, the first method showing recurrence, the mode of recurrence, reresectability, and survival were compared between the groups. RESULTS: The recurrences were identified earlier in the intensified follow-up group than in the conventional follow-up group (mean +/- SD, 10 +/- 5 months vs 15 +/- 10 months). The overall recurrence rate was 41%, with 39% in the conventional group and 42% in the intensified group. Carcinoembryonic antigen determination was the most common method showing recurrence in both groups. Endoscopy and ultrasound were beneficial in the intensified follow-up group, but computed tomography failed to improve the diagnostics. The mode of recurrence did not differ between the groups. Radical resections were performed on 19% (8/43) of the patients, 14% (3/21) in the conventional group and 22% (5/22) in the intensified group. The cumulative 5-year survival was 54% in the conventional group and 59% in the intensified group. CONCLUSION: Earlier detection of recurrent colorectal cancer by intensified follow-up does not lead to either significantly increased reresectability or improved 5-year survival.

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