Surveillance After Curative Resection of Colorectal Cancer: Individualizing Follow-Up

e14142 Background: Although FOLFOX regimen is shown to be effective to suppress the recurrence of stage III colorectal cancer (CRC) who received curative resection, the prophylactic effect of has not fully been investigated in adjuvant setting of stage IV CRC cases, namely, after curative resection of distant metastases. Methods: This is a retrospective study including 116 CRC patients with synchronous metastases and 91 with metachronous metastases who received curative resection in our hospital between 2000 and 2009. Pathological parameters of primary CRC, postoperative chemotherapeutic regimen, relapse-free survival (RFS) were analyzed retrospectively. Results: After resection of CRC and synchronous metastases, 53 (84%) out of 63 patients without chemotherapy, and 38 (83%) out of 46 that received oral or intravenous 5-fluorouracil (5-FU) alone or with leucovorin (LV) developed recurrent tumors. By contrast, only single patient (17%) among 6 who underwent FOLFOX showed recurrence. With a median follow-up period of 775 days, the FOLFOX group exhibited a significantly improved RFS as compared to the 5-FU(+LV) or surgery alone group (p=0.03, p=0.007, respectively). The 5-year OS rates of the surgery alone, 5-FU(+LV), and FOLFOX group were 67%, 75%, and 100%. In CRC cases with metachronous metastases, on the other hand, the recurrence rate of the group without chemotherapy was 63%, and that of the 5-FU (+LV) group 55%. In 7 patients who underwent FOLFOX chemotherapy (5 cases of FOLFOX4 and 2 cases of mFOLFOX6, no antibody therapy) after metastasectomy, 71% (5 patients) relapsed afterward. Thus, the tumor-relapse rate after metastasectomy was similar among patients who received no postoperative chemotherapy. The median RFSs of the surgery alone, 5-FU(+LV), and FOLFOX groups were 323, 917, and 322 days, respectively. Conclusions: Adjuvant FOLFOX is certainly beneficial for stage IV CRC patients with synchronous metastasis who received curative resection. In contrast, the prophylactic effect of FOLFOX is not superior to other follow-up strategies in patients who received complete resection of metachronous metastases.

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Follow-up strategies after curative resection of colorectal cancer

Seminars in Oncology ◽

10.1016/s0093-7754(03)00095-2 ◽

2003 ◽

Vol 30 (3) ◽

pp. 349-360 ◽

Cited By ~ 42

Author(s):

Jeffrey A. Meyerhardt ◽

Robert J. Mayer

Keyword(s):

Colorectal Cancer ◽

Curative Resection

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Intensive Follow-Up After Curative Surgery for Colorectal Cancer

Acta Médica Portuguesa ◽

10.20344/amp.7889 ◽

2017 ◽

Vol 30 (9) ◽

pp. 633 ◽

Cited By ~ 2

Author(s):

Rita Vale Rodrigues ◽

João Pereira da Silva ◽

Isadora Rosa ◽

Isabel Santos ◽

Nuno Pereira ◽

...

Keyword(s):

Colorectal Cancer ◽

Curative Resection ◽

Curative Treatment ◽

Rank Test ◽

Surveillance Program ◽

Curative Surgery ◽

Cancer Antigen ◽

Chi Square ◽

Postoperative Surveillance

Introduction: The purpose of postoperative surveillance programs after curative treatment for colorectal cancer is to detect asymptomatic recurrences with the premise that an important rate will be eligible for curative resection, improving overall survival. We have implemented a surveillance program for patients with colorectal cancer, stages II-III, with periodic clinical, carcinoembryonic antigen and cancer antigen-19-9 assessment, computed tomography and colonoscopy. The aim of this study was to assess the rate of curative treatment of recurrence, colorectal cancer mortality and clinical characteristics associated with non-resectable recurrence.Material and Methods: Open cohort study, single center. All patients on the intensive surveillance program between March 2008 and January 2015 were included. Statistics: chi-square, Wilcoxon rank sum test, logistic regression, Kaplan-Meier log-rank test (SPSS20®).Results: We had a total 404 patients evaluated; 59.6% male; mean age of 65 ± 10 years; 50.7% rectal tumor; 56.2% stage III. The average time of follow-up was 37 months and the recurrence rate was 12.9% (n = 52), mostly detected in the first three years (88.4%). The pattern of recurrence was associated with the site of the primary tumor (p < 0.001). Twenty-one patients underwent curative resection. Factors associated with non-resectable recurrence were aged ≥ 70 years (p = 0.022), disease location in the colon (p = 0.033) and cancer antigen-19-9-9 elevation (p = 0.024). The overall rate of cancer-specific mortality was 2.2% (n = 9).Discussion: The association between colon cancer and non-resectable recurrence is explained by the higher rate of disseminated disease in these patients. Cancer antigen-19-9 added no benefit to the surveillance program.Conclusion: This intensive real-world postoperative surveillance program allowed performing curative surgery to 40.3% of patients with recurrence.

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