Körner Hartwig, Söreide Kjetil, Stokkeland Pål J, Söreide Jon Arne
Institute of Surgical Sciences, University of Bergen, Bergen, Norway.
J Gastrointest Surg. 2005 Mar;9(3):320-8. doi: 10.1016/j.gassur.2004.09.023.
In this study, we analyzed the Norwegian guidelines for systematic follow-up after curative colorectal cancer surgery in a large single institution. Three hundred fourteen consecutive unselected patients undergoing curative surgery for colorectal cancer between 1996 and 1999 were studied with regard to asymptomatic curable recurrence, compliance with the program, and cost. Follow-up included carcinoembryonic antigen (CEA) interval measurements, colonoscopy, ultrasonography of the liver, and radiography of the chest. In 194 (62%) of the patients, follow-up was conducted according to the Norwegian guidelines. Twenty-one patients (11%) were operated on for curable recurrence, and 18 patients (9%) were disease free after curative surgery for recurrence at evaluation. Four metachronous tumors (2%) were found. CEA interval measurement had to be made most frequently (534 tests needed) to detect one asymptomatic curable recurrence. Follow-up program did not influence cancer-specific survival. Overall compliance with the surveillance program was 66%, being lowest for colonoscopy (55%) and highest for ultrasonography of the liver (85%). The total program cost was 228,117 euro (US 280,994 dollars), translating into 20,530 euro (US 25,289 dollars) for one surviving patient after surgery for recurrence. The total diagnosis yield with regard to disease-free survival after surgery for recurrence was 9%. Compliance was moderate. Whether the continuing implementation of such program and cost are justified should be debated.
在本研究中，我们分析了挪威一家大型单一机构中关于结直肠癌根治性手术后系统随访的指南。对1996年至1999年间连续314例接受结直肠癌根治性手术的未选择患者进行了无症状可治愈复发情况、对该方案的依从性及成本方面的研究。随访包括癌胚抗原（CEA）间隔测量、结肠镜检查、肝脏超声检查及胸部X线检查。194例（62%）患者按照挪威指南进行了随访。21例患者（11%）因可治愈复发接受了手术，18例患者（9%）在评估时复发根治性手术后无疾病。发现4例异时性肿瘤（2%）。检测一例无症状可治愈复发，CEA间隔测量需进行的次数最多（需要534次检测）。随访方案不影响癌症特异性生存。对监测方案的总体依从率为66%，结肠镜检查的依从率最低（55%），肝脏超声检查的依从率最高（85%）。该方案总成本为228,117欧元（280,994美元），复发手术后一名存活患者的成本为20,530欧元（25,289美元）。复发手术后无病生存方面的总诊断率为9%。依从性为中等。此类方案的持续实施及成本是否合理值得探讨。
