Ohlsson Björn, Pålsson Birger
Department of Surgery, Blekinge Hospital, Karlshamn Sweden.
Acta Oncol. 2003;42(8):816-26. doi: 10.1080/02841860310019016.
Although most institutions offer some kind of follow-up to patients operated on for colorectal cancer, its value with respect to prolonged survival has been challenged. However, improved results of liver surgery and chemotherapy make it reasonable to assume that a follow-up programme leading to detection of more asymptomatic recurrences would result in improved survival. Liver metastases and extramural local recurrences are the most common secondary lesions and 5-year survival rates of about 30% are reported after radical resection. From these observations a survival benefit could be expected when follow-up is directed to these forms of recurrence. From six randomized studies, six comparative cohort studies and four meta-analyses it can be concluded that an intensive follow-up programme results in more recurrences being resected for cure and about a 10% higher 5-year survival rate compared with less intensive or no follow-up. However, the differences in the follow-up protocols make it difficult to conclude how a follow-up programme should be designed. Liver imaging and carcinoembryonic antigen assay should probably be included, while the yield of frequent colonoscopies is small. A follow-up regimen based on these principles is suggested. Future studies should focus on which tests are the most cost-effective for follow-up after colorectal cancer resection.
尽管大多数机构对接受结直肠癌手术的患者提供某种形式的随访，但其对延长生存期的价值受到了质疑。然而，肝脏手术和化疗效果的改善使得有理由认为，一个能够检测出更多无症状复发的随访计划将提高生存率。肝转移和壁外局部复发是最常见的继发性病变，根治性切除术后报告的5年生存率约为30%。基于这些观察结果，当随访针对这些复发形式时，有望获得生存益处。从六项随机研究、六项比较队列研究和四项荟萃分析中可以得出结论，与随访强度较低或不进行随访相比，强化随访计划能使更多复发灶得以切除以实现治愈，且5年生存率提高约10%。然而，随访方案的差异使得难以确定应如何设计随访计划。肝脏成像和癌胚抗原检测可能应包括在内，而频繁进行结肠镜检查的收益较小。建议基于这些原则制定随访方案。未来的研究应关注哪些检测对于结直肠癌切除术后的随访最具成本效益。
